Benjamin Dale Fortson, MPO, CPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

CPO04027 Issued in DE

Practice address

15200 Shady Grove Rd Ste 102
Rockville, MD 20850-3218

Phone

(240) 261-4229

Fax

(240) 261-4489

NPI assigned

Mar 8, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1497296537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15200 SHADY GROVE RD STE 102",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503218",
            "telephone_number": "240-261-4229",
            "fax_number": "240-261-4489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15200 SHADY GROVE RD STE 102",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503218",
            "telephone_number": "240-261-4229",
            "fax_number": "240-261-4489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 Thomas Johnson Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024426",
            "country_code": "US",
            "telephone_number": "301-698-4692",
            "fax_number": "301-698-4693",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTSON",
        "first_name": "BENJAMIN",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "MPO, CPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-08",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "DE",
            "license": "CO005694",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "DE",
            "license": "CPO04027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetist in Rockville, MD
• Providers in Rockville, MD by specialty
• Prosthetist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.