Provider Demographics
NPI:1740424621
Name:KINNEAR, BENJAMIN R (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:KINNEAR
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 1:3333 BURNET AVE # 9016
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-803-8092
Mailing Address - Fax:513-803-9245
Practice Address - Street 1:3333 BURNET AVE # 9016
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-803-8092
Practice Address - Fax:513-803-9245
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096918207R00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0083571Medicaid
IN201160520Medicaid
KY7100240420Medicaid
OHH049001Medicare PIN