Provider Demographics
NPI:1760266910
Name:NASH, BENJAMIN (PR)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:NASH
Suffix:
Gender:M
Credentials:PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W CIRCLE APT 3
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-7690
Mailing Address - Country:US
Mailing Address - Phone:304-580-8551
Mailing Address - Fax:
Practice Address - Street 1:137 8TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2510
Practice Address - Country:US
Practice Address - Phone:304-408-3256
Practice Address - Fax:304-756-8230
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23-9116175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty