=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154068799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN THOMAS CUTCHINS PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2022
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 BALDWIN BLVD
-----------------------------------------------------
City | FISHERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22939-2375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-377-7784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29410 CUTCHINS DR
-----------------------------------------------------
City | NEWSOMS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23874-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-377-7784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0110008839
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------