Provider Demographics
NPI:1558928119
Name:PARKER-GOOS, BENJAMIN H (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:H
Last Name:PARKER-GOOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1711 GREEN ST APT K
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4303
Mailing Address - Country:US
Mailing Address - Phone:917-453-1902
Mailing Address - Fax:215-503-6116
Practice Address - Street 1:833 CHESTNUT ST STE 210
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4405
Practice Address - Country:US
Practice Address - Phone:215-955-8420
Practice Address - Fax:215-503-0429
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4806622084P0802X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry