Basic Information
Provider Information | |||||||||
NPI: | 1497850515 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHARFSTEIN | ||||||||
FirstName: | BENJAMIN | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 MEDICAL PARK BLVD | ||||||||
Address2: | 250 WEST | ||||||||
City: | BRISTOL | ||||||||
State: | TN | ||||||||
PostalCode: | 376207430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4238446620 | ||||||||
FaxNumber: | 4238446627 | ||||||||
Practice Location | |||||||||
Address1: | 1 MEDICAL PARK BLVD | ||||||||
Address2: | 250 WEST | ||||||||
City: | BRISTOL | ||||||||
State: | TN | ||||||||
PostalCode: | 376207430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4238446620 | ||||||||
FaxNumber: | 4238446627 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2006 | ||||||||
LastUpdateDate: | 09/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 34037 | TN | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 3882258 | 05 | TN |   | MEDICAID | 266804 | 01 | TN | INDIV ANTHEM/GROUP#093410 | OTHER | TN0107 | 01 | TN | JOHN DEERE NOW UNITED HC | OTHER | 022276800 | 01 | TN | BLACK LUNG GROUP | OTHER | 7314019 | 05 | VA |   | MEDICAID | 0636398 | 01 | TN | UMWA GROUP | OTHER | 4059514 | 01 | TN | BCBS OF TENNESSEE | OTHER | P00007322 | 01 | TN | MCRAILROAD/GROUP#CA8128 | OTHER | 7032445 | 01 | TN | AETNA | OTHER | F03906748 | 01 | TN | CHAMPUS GROUP | OTHER |