Healthcare Provider Details

I. General information

NPI: 1902004047
Provider Name (Legal Business Name): BEN J KOCHUVELI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HUNTINGDON PIKE 100
ROCKLEDGE PA
19046-4338
US

IV. Provider business mailing address

8 HUNTINGDON PIKE 100
ROCKLEDGE PA
19046-4338
US

V. Phone/Fax

Practice location:
  • Phone: 215-663-8880
  • Fax: 215-663-8898
Mailing address:
  • Phone: 215-663-8880
  • Fax: 215-663-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125053442
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD440944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: