Healthcare Provider Details

I. General information

NPI: 1093937047
Provider Name (Legal Business Name): BENJAMIN T ISBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENTARA CIR STE 105
WILLIAMSBURG VA
23188-5754
US

IV. Provider business mailing address

6353 CENTER DR STE 100
NORFOLK VA
23502-4100
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-5653
  • Fax: 757-378-2776
Mailing address:
  • Phone: 561-486-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116017467
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101245607
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: