Healthcare Provider Details

I. General information

NPI: 1336148865
Provider Name (Legal Business Name): BENJAMIN S BOLSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML9016
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML9016
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-8092
  • Fax: 513-803-9245
Mailing address:
  • Phone: 513-803-8092
  • Fax: 513-803-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.081505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: