Provider Demographics
NPI:1700954237
Name:BENJAMIN, MARIAM (MD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 FISHINGER BLVD
Mailing Address - Street 2:SUITE 285
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7504
Mailing Address - Country:US
Mailing Address - Phone:614-527-2562
Mailing Address - Fax:614-527-2571
Practice Address - Street 1:3535 FISHINGER BLVD
Practice Address - Street 2:SUITE 285
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7504
Practice Address - Country:US
Practice Address - Phone:614-527-2562
Practice Address - Fax:614-527-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2800526Medicaid
OH4225922Medicare PIN
OH2800526Medicaid