Healthcare Provider Details

I. General information

NPI: 1306578364
Provider Name (Legal Business Name): BENJAMIN BORRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISION OF GENERAL PEDIATRICS
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

100 WOODRUFF CIR NE STE P375
ATLANTA GA
30322-1020
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1220
  • Fax:
Mailing address:
  • Phone: 404-727-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT236188
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: