Provider Demographics
NPI:1134180540
Name:PENTZ, BENJAMIN MICHAEL VII (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:PENTZ
Suffix:VII
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 1:150 N CRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3417
Mailing Address - Country:US
Mailing Address - Phone:330-652-1990
Mailing Address - Fax:330-652-1914
Practice Address - Street 1:150 N CRANDON AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3417
Practice Address - Country:US
Practice Address - Phone:330-652-1990
Practice Address - Fax:330-652-1914
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052833208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0634139Medicaid
E76028Medicare UPIN