Provider Demographics
NPI:1487061289
Name:PEASE, BENJAMIN
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:PEASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 ELKRIDGE LANDING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2958
Mailing Address - Country:US
Mailing Address - Phone:774-264-0423
Mailing Address - Fax:732-605-5932
Practice Address - Street 1:785 ELKRIDGE LANDING RD STE 300
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-2958
Practice Address - Country:US
Practice Address - Phone:774-264-0423
Practice Address - Fax:732-605-5932
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213031363LA2100X, 363LC0200X, 363LC0200X
CA95000951363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541033900Medicaid
MD389009Y3WMedicare PIN