Provider Demographics
NPI:1497856371
Name:PINNER, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PINNER
Suffix:
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:PEAK
Mailing Address - State:SC
Mailing Address - Zip Code:29122-0099
Mailing Address - Country:US
Mailing Address - Phone:803-945-9029
Mailing Address - Fax:803-345-2832
Practice Address - Street 1:32 RIVER STREET
Practice Address - Street 2:
Practice Address - City:PEAK
Practice Address - State:SC
Practice Address - Zip Code:29122-0099
Practice Address - Country:US
Practice Address - Phone:803-945-9029
Practice Address - Fax:803-345-2832
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC269667Medicaid
SC269667Medicaid