Provider Demographics
NPI:1902004047
Name:KOCHUVELI, BEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:J
Last Name:KOCHUVELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 HUNTINGDON PIKE
Mailing Address - Street 2:100
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4338
Mailing Address - Country:US
Mailing Address - Phone:215-663-8880
Mailing Address - Fax:215-663-8898
Practice Address - Street 1:8 HUNTINGDON PIKE
Practice Address - Street 2:100
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4338
Practice Address - Country:US
Practice Address - Phone:215-663-8880
Practice Address - Fax:215-663-8898
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053442207Q00000X
PAMD440944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP
PA100727800OtherMEDICAID GROUP
PA102528978Medicaid
PA597586OtherMEDICARE GROUP