Healthcare Provider Details

I. General information

NPI: 1801419247
Provider Name (Legal Business Name): BENJAMIN A KESTENBAUM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 10/09/2024
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 JENNIFER ROAD STE 240
ANNAPOLIS MD
21401-7995
US

IV. Provider business mailing address

170 JENNIFER ROAD STE 240
ANNAPOLIS MD
21401-7995
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9000
  • Fax: 410-266-1507
Mailing address:
  • Phone: 410-571-9000
  • Fax: 410-266-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH0099857
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberH0099857
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS18606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: