Basic Information
| Provider Information | |||||||||
| NPI: | 1497071872 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEMOINE | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443111518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305931049 | ||||||||
| FaxNumber: | 3305723836 | ||||||||
| Practice Location | |||||||||
| Address1: | 484 KING ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305931049 | ||||||||
| FaxNumber: | 3305723836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2010 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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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 | 2085R0202X | 35.134522 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0307416 | 05 | OH | MEDICAID | 1035443860001 | 05 | PA | MEDICAID |