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NPI Code Detail

MEDICARE: BENJAMIN DAVID KNICK DO

MEDICARE: BENJAMIN DAVID KNICK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1508669045
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN DAVID KNICK DO
Provider Business Mailing Address
First Line : 2145 MOUNT PLEASANT BLVD SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-3632
Country : US
Telephone Number : 540-427-9200
Fax Number :
Provider Business Practice Location Address
First Line : 1906 BELLEVIEW AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1838
Country : US
Telephone Number : 540-981-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2025
Last Update Date : 06/04/2026

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