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General NPI Number Information
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NPI Number | 1932561792
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Entity Type | Individual
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Provider Name | BENJAMIN TATE FEDELES M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 234 GOODMAN ST
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City | CINCINNATI
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State | OH
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Zip | 45219-2364
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Country | US
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Telephone | 513-475-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 10500 MONTGOMERY RD
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City | MONTGOMERY
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State | OH
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Zip | 45242-4402
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Country | US
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Telephone | 513-865-2246
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Fax | 513-865-5552
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.142433
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 35.142433
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License Number State | OH
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