Healthcare Provider Details

I. General information

NPI: 1306093372
Provider Name (Legal Business Name): BENJAMIN RYAN PHELPS MD, MPH, CTROPMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PENNSYLVANIA AVE NW OFFICE OF HIV/AIDS, 5.10.43
WASHINGTON DC
20004-3002
US

IV. Provider business mailing address

1300 PENNSYLVANIA AVE NW OFFICE OF HIV/AIDS, 5.10.43
WASHINGTON DC
20004-3002
US

V. Phone/Fax

Practice location:
  • Phone: 202-316-3034
  • Fax:
Mailing address:
  • Phone: 202-316-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD038610
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: