Provider Demographics
NPI:1679857239
Name:DIFFENDERFER, BENJAMIN WILLIAMS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WILLIAMS
Last Name:DIFFENDERFER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:510 UPPER CHESAPEAKE DR., SUITE 417
Mailing Address - Street 2:PHYSICIANS PAVILLION II
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:443-643-3130
Mailing Address - Fax:443-643-3155
Practice Address - Street 1:510 UPPER CHESAPEAKE DR., SUITE 417
Practice Address - Street 2:PHYSICIANS PAVILLION II
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:443-643-3130
Practice Address - Fax:443-643-3155
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
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Provider Licenses
StateLicense IDTaxonomies
MDC0004567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant