Individual
MR. BENJAMIN R PROTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
860 OMNI BLVD, SUITE 113, NEWPORT NEWS, VA 23606
(757) 327-0657
(757) 327-0658
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606
(757) 232-8777
(757) 232-8866
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103300835
VA
213ES0103X
Foot & Ankle Surgery Podiatrist
0103300835
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073506291
—
VA
01
—
236542
ANTHEM PROVIDER NUMBER
VA
01
—
394596
MDIPA/MAMSI PROVIDER NUM
VA
01
—
58381
OPTIMA PROVIDER NUMBER
VA
05
—
9304797
—
VA
Enumeration date
08/23/2005
Last updated
12/14/2016
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