Provider Demographics
NPI: | 1558865071 |
---|---|
Name: | PARKER, BENJAMIN STANLEY (MD, MBA) |
Entity Type: | Individual |
Prefix: | |
First Name: | BENJAMIN |
Middle Name: | STANLEY |
Last Name: | PARKER |
Suffix: | |
Gender: | M |
Credentials: | MD, MBA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3400 CIVIC CENTER BLVD FL 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19104-5161 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-662-3202 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3400 CIVIC CENTER BLVD FL 1 |
Practice Address - Street 2: | |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19104-5161 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-662-3202 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-03-20 |
Last Update Date: | 2023-02-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD472615 | 207RC0200X, 207RP1001X |
MA | 283184 | 207R00000X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |