Healthcare Provider Details

I. General information

NPI: 1013649607
Provider Name (Legal Business Name): BENJAMIN GREGORY HASELHUHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MORRIS RD
CIRCLEVILLE OH
43113-1362
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-477-6511
  • Fax:
Mailing address:
  • Phone: 740-477-6511
  • Fax: 740-477-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007565RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: