Provider Demographics
NPI:1295788412
Name:CONTRERAS, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CONTRERAS
Suffix:
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 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5000
Mailing Address - Fax:804-435-2688
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5000
Practice Address - Fax:804-435-2688
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248788207L00000X
FLME62685208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18163OtherFL BCBS NUMBER
FLP00214149OtherMEDICARE RAILROAD
FL371535300Medicaid
FLP00214149OtherMEDICARE RAILROAD
FLF42128Medicare UPIN
FL18163UMedicare ID - Type UnspecifiedFL MEDICARE - INDIVIDUAL
FL18163SMedicare ID - Type UnspecifiedGTBA MEDICARE
FL371535300Medicaid
VAVV0708AMedicare PIN