Healthcare Provider Details

I. General information

NPI: 1326722976
Provider Name (Legal Business Name): BENJAMIN WILLIAM ZOLLINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

413 S LEE ST
ALEXANDRIA VA
22314-3815
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax:
Mailing address:
  • Phone: 318-450-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0116038376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: