Provider Demographics
NPI:1346210044
Name:CHOTINER, BENNETT (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:
Last Name:CHOTINER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1071
Mailing Address - Country:US
Mailing Address - Phone:717-657-2020
Mailing Address - Fax:717-657-2071
Practice Address - Street 1:4100 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1071
Practice Address - Country:US
Practice Address - Phone:717-657-2020
Practice Address - Fax:717-657-2071
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014204E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008116800001Medicaid
PA0008116800001Medicaid
PAB34863Medicare UPIN