MEDICARE: JOHN NOLT BENNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD071869E	PA

General Provider Information

NPI Number	:	1538161468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NOLT BENNER MD

Provider Business Mailing Address
First Line	:	1425 PHILADELPHIA AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1386
Country	:	US
Telephone Number	:	717-261-4194
Fax Number	:	717-261-4319

Provider Business Practice Location Address
First Line	:	1425 PHILADELPHIA AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1386
Country	:	US
Telephone Number	:	717-261-4194
Fax Number	:	717-261-4319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/05/2007

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