Provider Demographics
NPI:1356040067
Name:SPECHT, BENJAMIN
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:SPECHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:BRADFORDWOODS
Mailing Address - State:PA
Mailing Address - Zip Code:15015-1305
Mailing Address - Country:US
Mailing Address - Phone:440-292-5408
Mailing Address - Fax:
Practice Address - Street 1:19 COMMONS DR
Practice Address - Street 2:
Practice Address - City:BRADFORDWOODS
Practice Address - State:PA
Practice Address - Zip Code:15015-1305
Practice Address - Country:US
Practice Address - Phone:440-292-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant