Organization
BENEDETTO DERMATOLOGY, LLC
Active
Organization
BENEDETTO DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY V BENEDETTO D.O. (MEDICAL DIRECTOR)
(215) 546-3666
Entity
Organization
Contact information
Practice address
1200 LOCUST ST, PHILADELPHIA, PA 19107-5605
(215) 546-3666
(215) 546-6060
Mailing address
1200 LOCUST ST, PHILADELPHIA, PA 19107-5605
(215) 546-3666
(215) 546-6060
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
207ND0101X
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0274011000
INDEPENDENCE BLUE CROSS
PA
01
—
101750
HIGHMARK BLUE SHIELD
PA
Enumeration date
02/11/2008
Last updated
12/16/2014
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