Healthcare Provider Details

I. General information

NPI: 1518997071
Provider Name (Legal Business Name): BENJAMIN MARSH BRASLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NORTH 39TH STREET
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

3400 SPRUCE STREET 5 MALONEY
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8310
  • Fax: 215-724-3560
Mailing address:
  • Phone: 215-349-8310
  • Fax: 215-724-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD066263L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD066263L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: