Provider Demographics
NPI:1114960564
Name:BENNER, JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:BENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 OLD FERN HILL RD
Mailing Address - Street 2:SUITE 1 B-A
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-692-6280
Mailing Address - Fax:610-429-1943
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:SUITE 1 B-A
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-692-6280
Practice Address - Fax:610-429-1943
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015472E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0711540Medicaid
PA025388NU9Medicare PIN
B33524Medicare UPIN
PA0711540Medicaid