Provider Demographics
NPI:1942745930
Name:NETH, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:NETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 ROLLING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8525 ROLLING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3647
Practice Address - Country:US
Practice Address - Phone:703-257-2266
Practice Address - Fax:703-257-2269
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1136085OtherNCCPA
VA0110-005567OtherVIRGINIA BOARD OF MEDICINE
VA0110-005567OtherVIRGINIA BOARD OF MEDICINE