Provider Demographics
NPI:1932331204
Name:THORPE, BENJAMIN B
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:B
Last Name:THORPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:B
Other - Last Name:THORPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4433 HANNAH FORD RD
Mailing Address - Street 2:
Mailing Address - City:PEGRAM
Mailing Address - State:TN
Mailing Address - Zip Code:37143-2018
Mailing Address - Country:US
Mailing Address - Phone:615-418-0401
Mailing Address - Fax:
Practice Address - Street 1:4433 HANNAH FORD RD
Practice Address - Street 2:
Practice Address - City:PEGRAM
Practice Address - State:TN
Practice Address - Zip Code:37143-2018
Practice Address - Country:US
Practice Address - Phone:615-418-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800695174400000X
TN405511174400000X
SC2663174400000X
NC6263174400000X
GAOTA 000911174400000X
CA1855174400000X
MO2005018513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist