Provider Demographics
NPI:1710069893
Name:UBERTI-BENZ, MARIA O (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:O
Last Name:UBERTI-BENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N 39TH STREET
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE 106
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8060
Mailing Address - Fax:
Practice Address - Street 1:51 N 39TH STREET
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 106
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023503E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000904395Medicaid
PA000904395Medicaid
PAB25322Medicare UPIN