Healthcare Provider Details

I. General information

NPI: 1518877307
Provider Name (Legal Business Name): BENJAMIN CHARLES BERKEBILE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

118 MIZEL LN
JOHNSTOWN PA
15902-1327
US

V. Phone/Fax

Practice location:
  • Phone: 421-647-2345
  • Fax:
Mailing address:
  • Phone: 814-421-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA068215
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: