Healthcare Provider Details

I. General information

NPI: 1356419246
Provider Name (Legal Business Name): BENJAMIN GUY WITHERS MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD DEWITT HEALTH CARE NETWORK
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

8616 W BOULEVARD DR
ALEXANDRIA VA
22308-2031
US

V. Phone/Fax

Practice location:
  • Phone: 703-806-4586
  • Fax: 703-806-3591
Mailing address:
  • Phone: 703-799-1311
  • Fax: 703-806-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number0101052172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: