Provider Demographics
NPI:1154303493
Name:TACHERON, BEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:TACHERON
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 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:855-527-7246
Mailing Address - Fax:668-229-5063
Practice Address - Street 1:6503 DEER POINTE DR STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1674
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:866-229-5063
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035409207L00000X
AZ47720207LP2900X
MDD35409207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47720OtherSTATE MEDICAL LICENSE
CODR.0050597OtherSTATE MEDICAL LICENSE
AZ884589Medicaid
MDE25330Medicare UPIN
AZZ180633Medicare PIN
AZ47720OtherSTATE MEDICAL LICENSE