Individual
BENJAMIN PETERSEN SOULE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 N 39TH ST, MUTCH BLDG. 5TH FLOOR, PHILADELPHIA, PA 19104-2640
(215) 662-2775
(215) 662-3440
Mailing address
51 N 39TH ST, MUTCH BLDG. 5TH FLOOR, PHILADELPHIA, PA 19104-2640
(215) 662-2775
(215) 662-3440
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD440070
PA
207R00000X
Internal Medicine Physician
MD440070
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
415096100
—
MD
01
—
MD440070
MEDICAL LICENSE
PA
Enumeration date
10/31/2005
Last updated
02/15/2022
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