MEDICARE: DR. BENITA M PETRI PICKSTONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35072471	OH

General Provider Information

NPI Number	:	1013970565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENITA M PETRI PICKSTONE MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-5123
Fax Number	:	614-293-4980

Provider Business Practice Location Address
First Line	:	920 N HAMILTON RD
Second Line	:	SUITE 300
City	:	GAHANNA
State	:	OH
Zip	:	43230-1757
Country	:	US
Telephone Number	:	614-293-5123
Fax Number	:	614-293-4980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/07/2025

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