Provider Demographics
NPI:1457357741
Name:DERATZOU, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:DERATZOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1548
Mailing Address - Country:US
Mailing Address - Phone:215-453-4550
Mailing Address - Fax:
Practice Address - Street 1:700 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1548
Practice Address - Country:US
Practice Address - Phone:215-453-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-045886-L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113861400OtherDEPARTMENT OF LABOR
PA7581234OtherCIGNA
PA0555124000OtherINDEPENDENCE BLUE CROSS
PA1488614Medicaid
PA22-1994560OtherHEALTH AMERICA/HEALTH AMERICA
PA4402138OtherAETNA
PA22-1994560OtherFIRST MCO
PA22-1994560OtherDEVON
PA718211OtherHIGHMARK BLUE SHIELD
PAP00661480OtherRAILROAD MEDICARE
PAP00661480OtherRAILROAD MEDICARE
PA22-1994560OtherDEVON
PA0555124000OtherINDEPENDENCE BLUE CROSS
PA22-1994560OtherHEALTH AMERICA/HEALTH AMERICA