Provider Demographics
NPI:1497280028
Name:MASSENBURG, BENJAMIN BALLARD V (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BALLARD
Last Name:MASSENBURG
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE MAIL STOP #359796
Mailing Address - Street 2:7TH FLOOR CENTER TOWER ROOM 73.1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-2868
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE., MAIL STOP #359796
Practice Address - Street 2:7TH FLOOR CENTER TOWER ROOM 73.1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program