Healthcare Provider Details

I. General information

NPI: 1154303493
Provider Name (Legal Business Name): BEN TACHERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 DEER POINTE DR STE A
SALISBURY MD
21804-1674
US

IV. Provider business mailing address

201 DEFENSE HWY STE 205
ANNAPOLIS MD
21401-7096
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7246
  • Fax: 866-229-5063
Mailing address:
  • Phone: 855-527-7246
  • Fax: 668-229-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0035409
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number47720
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD35409
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: