Healthcare Provider Details

I. General information

NPI: 1235755331
Provider Name (Legal Business Name): JESSICA BENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 W ONTARIO ST
PHILADELPHIA PA
19140-5220
US

IV. Provider business mailing address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-8496
  • Fax: 215-707-4086
Mailing address:
  • Phone: 215-707-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD484328
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: