Provider Demographics
NPI: | 1700229317 |
---|---|
Name: | CARRLE, BENJAMIN AARON (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | BENJAMIN |
Middle Name: | AARON |
Last Name: | CARRLE |
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: | 12029 SHERATON LN |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45246-1611 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-874-8111 |
Mailing Address - Fax: | 513-860-6992 |
Practice Address - Street 1: | 12029 SHERATON LN |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45246-1611 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-874-8111 |
Practice Address - Fax: | 513-860-6992 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-04-12 |
Last Update Date: | 2020-05-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35.127041 | 2085R0204X, 2085R0202X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |