Provider Demographics
NPI:1770166670
Name:MILLER, BENJAMIN (RD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SAWMILL PLACE BLVD APT 152
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5228
Mailing Address - Country:US
Mailing Address - Phone:330-401-6512
Mailing Address - Fax:
Practice Address - Street 1:2350 SAWMILL PLACE BLVD APT 152
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5228
Practice Address - Country:US
Practice Address - Phone:330-401-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86175658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered