Healthcare Provider Details

I. General information

NPI: 1972706448
Provider Name (Legal Business Name): BENJAMIN LESLIE KREPPS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 WILLIAMSPORT PIKE
MARTINSBURG WV
25404-4341
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-2378
  • Fax:
Mailing address:
  • Phone: 703-914-8000
  • Fax: 410-329-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0102202963
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH0076404
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberH0076404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: