Provider Demographics
NPI:1942421508
Name:MASTRIDGE, BENJAMIN JOSEPH (MSN, PMHAPRN-BC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:MASTRIDGE
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Gender:M
Credentials:MSN, PMHAPRN-BC
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Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-0400
Mailing Address - Country:US
Mailing Address - Phone:919-529-2474
Mailing Address - Fax:919-529-2143
Practice Address - Street 1:402 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8815
Practice Address - Country:US
Practice Address - Phone:919-529-2474
Practice Address - Fax:919-529-2143
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC195355163WP0808X
NC5005347363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113119Medicaid