Healthcare Provider Details

I. General information

NPI: 1992221972
Provider Name (Legal Business Name): MR. BENJAMIN FRANKLIN PETWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6013 ZURICH DRIVE
RICHMOND VA
23224
US

IV. Provider business mailing address

6013 ZURICH DR
RICHMOND VA
23224-4527
US

V. Phone/Fax

Practice location:
  • Phone: 804-683-1296
  • Fax:
Mailing address:
  • Phone: 804-683-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: