Provider Demographics
NPI:1437333770
Name:WARNER, BENJAMIN WELTON (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WELTON
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:132 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9011
Practice Address - Country:US
Practice Address - Phone:369-832-5313
Practice Address - Fax:336-983-2532
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC135599390200000X
NC2009-01043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912452Medicaid
NC135599OtherTRAINING LICENSE NUMBER
NC60133BMedicare UPIN