Provider Demographics
NPI:1336617778
Name:CHITU, BENIAMIN (PA-C)
Entity Type:Individual
Prefix:
First Name:BENIAMIN
Middle Name:
Last Name:CHITU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:CHITU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:8378 LEXIE LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5793
Mailing Address - Country:US
Mailing Address - Phone:865-765-4443
Mailing Address - Fax:
Practice Address - Street 1:123 CONSTITUTION DR.
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-6754
Practice Address - Country:US
Practice Address - Phone:865-765-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-04
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3858363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty