KASSANOFF, BENJAMIN E (MD)

Provider Demographics

• NPI: 1356345680
• Name: KASSANOFF, BENJAMIN E (MD)
• Entity type: Individual
• Prefix: DR
• First Name: BENJAMIN
• Middle Name: E
• Last Name: KASSANOFF
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 501 E HAMPDEN AVE
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80113-2702
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2005-05-31
• Last Update Date: 2024-03-29

Provider Licenses

State	License ID	Taxonomies
TX	J2121	2085R0202X
HI	MD17552	2085R0202X
NE	25137	2085R0202X
KS	04-36295	2085R0202X
CO	44004	2085R0202X
CO	DR.0044004	2085R0204X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0204X	Allopathic & Osteopathic Physicians	Radiology	Vascular & Interventional Radiology
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	10025709000	Medicaid
CA	1356345680	Medicaid
MT	1356345680	Medicaid
WY	1356345680	Medicaid
NM	91031087	Medicaid
OK	100160560A	Medicaid
CO	41522257	Medicaid
NE	84059792913	Medicaid
NV	1356345680	Medicaid
KS	200360190A	Medicaid
NE	84059792913	Medicaid
NE	NA2517045	Medicare PIN
CO	P00266078	Medicare PIN
TX	103639401	Medicare PIN
CO	CO304760	Medicare PIN
CO	C803700	Medicare PIN
CO	C803698	Medicare PIN
CO	41522257	Medicaid
NV	1356345680	Medicaid
CO	P01384843	Medicare PIN
WY	1356345680	Medicaid
TX	83615R	Medicare UPIN
NE	NA1215032	Medicare PIN
NE	NA1214032	Medicare PIN
KS	200360190A	Medicaid
CO	392224ZLJ3	Medicare PIN
KS	111257051	Medicare PIN