Healthcare Provider Details

I. General information

NPI: 1225419252
Provider Name (Legal Business Name): BENJAMIN WELLS WESTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-4321
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-9680
  • Fax: 803-774-9680
Mailing address:
  • Phone: 843-876-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38198
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: