Provider Demographics
NPI:1932356508
Name:WYCHERLY, BENJAMIN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:WYCHERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21 SOUTH ROAD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-284-4950
Mailing Address - Fax:860-284-4951
Practice Address - Street 1:21 SOUTH ROAD
Practice Address - Street 2:PROHEALTH PHYSICIANS
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-284-4950
Practice Address - Fax:860-284-4951
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT049616207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology