Healthcare Provider Details

I. General information

NPI: 1457677536
Provider Name (Legal Business Name): STEFANIE WOOLRIDGE BENOIT M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 7022
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC 7022
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4531
  • Fax: 513-636-7407
Mailing address:
  • Phone: 513-636-4531
  • Fax: 513-636-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.099373
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35.099373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: