Healthcare Provider Details

I. General information

NPI: 1558928119
Provider Name (Legal Business Name): BENJAMIN H PARKER-GOOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 210
PHILADELPHIA PA
19107-4405
US

IV. Provider business mailing address

1711 GREEN ST APT K
PHILADELPHIA PA
19130-4303
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8420
  • Fax: 215-503-0429
Mailing address:
  • Phone: 917-453-1902
  • Fax: 215-503-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD480662
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: