Provider Demographics
NPI:1902223993
Name:BENJAMIN, COLLEEN (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1650 HUNTINGDON PIKE STE 320
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8007
Mailing Address - Country:US
Mailing Address - Phone:215-947-1447
Mailing Address - Fax:
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 320
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8007
Practice Address - Country:US
Practice Address - Phone:215-947-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics