Pettus, Benjamin J

Pettus, Benjamin J is an individual health care provider with primary practice located at 500 J. Clyde Morris Blvd Riverside Regional Medical Center, Newport News VA 23601-1929. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Pettus, Benjamin J can be contacted via phone (757) 594-4405.

Contact Information

Primary practice address
500 J. Clyde Morris Blvd Riverside Regional Medical Center Newport News VA 23601-1929
Phone: (757) 594-4405
Fax: (757) 867-6587
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 2010003256 Missouri
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 0101249325 Virginia

Profile Details

NPI number 1770596959
LBN Legal business name Pettus, Benjamin J
Credentials M.D., PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2006
Last updated Jan 9th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770596959 NPPES
Virginia Other P00980578 RAILROAD MEDICARE

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