Provider Demographics
NPI:1588838965
Name:HERRICK, BENJAMIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:W
Last Name:HERRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5507 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-0821
Mailing Address - Country:US
Mailing Address - Phone:603-727-2679
Mailing Address - Fax:
Practice Address - Street 1:509 N ELAM AVE FL 2
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1157
Practice Address - Country:US
Practice Address - Phone:336-274-1114
Practice Address - Fax:336-274-9638
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201401490208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology