Healthcare Provider Details

I. General information

NPI: 1447716139
Provider Name (Legal Business Name): BEN ONNINK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE SW BLDG 1300
BOLLING AFB DC
20032-7704
US

IV. Provider business mailing address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

V. Phone/Fax

Practice location:
  • Phone: 202-767-1051
  • Fax:
Mailing address:
  • Phone: 240-612-2473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101270438
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101270438
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: