Individual
BENJAMIN MATERI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1259 S CEDAR CREST BLVD STE 301, ALLENTOWN, PA 18103-6206
(610) 402-9400
(610) 437-8807
Mailing address
3400 SPRUCE STREET, 4 SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4206
(215) 615-4949
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD420325
PA
2086S0129X
Vascular Surgery Physician
Primary
MD420325
PA
2086S0129X
Vascular Surgery Physician
MT047810T
PA
Other
Enumeration date
12/29/2006
Last updated
07/18/2022
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