MEDICARE: BENJAMIN PAUL ANTHONY M.D.

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	207Y00000X	Otolaryngology Physician	BP10037187	TX
2	207Y00000X	Otolaryngology Physician	01076968A	IN
3	207Y00000X	Otolaryngology Physician	73698	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457666943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN PAUL ANTHONY M.D.

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 W 16TH ST STE 3200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2280
Country	:	US
Telephone Number	:	317-963-7082
Fax Number	:	317-963-7085

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	01/25/2021

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