MEDICARE: COOPER ROTH BENSON 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	208800000X	Urology Physician	308825	LA
2	208800000X	Urology Physician	T2324	TX
3	208800000X	Urology Physician	286338-01	NY
4	208800000X	Urology Physician	35C.001715	OH

General Provider Information

NPI Number	:	1760781645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COOPER ROTH BENSON MD

Provider Business Mailing Address
First Line	:	PO BOX 738291
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-8291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL CENTER DR STE 500
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45005-5183
Country	:	US
Telephone Number	:	513-423-2244
Fax Number	:

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	07/14/2025

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