Basic Information
| Provider Information | |||||||||
| NPI: | 1184283889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEWETT | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 ASHLEY AVENUE | ||||||||
| Address2: | ROOM 202 MUH, MSC 333 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437923221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 171 ASHLEY AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437922300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2019 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | LL82760 | SC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.