Provider Demographics
NPI:1881987394
Name:LISTON, BENJAMIN D (CPNP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:D
Last Name:LISTON
Suffix:
Gender:M
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 RIVERSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1738
Mailing Address - Country:US
Mailing Address - Phone:614-459-4200
Mailing Address - Fax:614-459-1589
Practice Address - Street 1:3300 RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-1738
Practice Address - Country:US
Practice Address - Phone:614-459-4200
Practice Address - Fax:614-459-1589
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12323-NP363LP0200X
OH12323-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty