| Provider / Organization | NPI | Date Certified |
|---|---|---|
| BENJAMIN MAXIMILIAN VANNORDEN TARTTER | 1720668031 | 2021-04-11 |
Benjamin Maximilian Vannorden Tartter is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1720668031. Registration indicates Benjamin Maximilian Vannorden Tartter is a provider of access to adult/geriatric primary care providers services with a specialization in Allopathic & Osteopathic Physicians, General Practice Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, General Practice) (Allopathic & Osteopathic Physicians, General Practice) (General Practice, ) (Primary Care/Family Planning/APRN/PA, ) (General Practice, Allopathic & Osteopathic Physicians) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Benjamin Maximilian Vannorden Tartter |
| Practice Office Address | 3525 SOUTHERN BLVD KETTERING, OH US |
| Practice Office Telephone | 9373958839 |
| Practice Office Fax | 9373958387 |
| Mailing Address | 3525 SOUTHERN BLVD KETTERING, OH 454291221 US |
| Business Telephone | 9373958839 |
| Business Fax | 9373958387 |
| Code | Practice | License No State |
|---|---|---|
| 208D00000X | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians General PracticeAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians General Practice Allopathic & Osteopathic Physicians General Practice General Practice Primary Care/Family Planning/APRN/PA General Practice Allopathic & Osteopathic Physicians | 320722
NY |
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |