Provider Demographics
NPI:1700035631
Name:BENEDICT, JOHN FITZGERALD KENNEDY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FITZGERALD KENNEDY
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1658
Mailing Address - Country:US
Mailing Address - Phone:610-745-5328
Mailing Address - Fax:
Practice Address - Street 1:115 KNOLL DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1658
Practice Address - Country:US
Practice Address - Phone:610-745-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053621363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical