Healthcare Provider Details

I. General information

NPI: 1104813468
Provider Name (Legal Business Name): JEROME V BENZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/28/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 KENNETH RD STE 1
YORK PA
17408-6344
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 717-767-2000
  • Fax: 717-767-2013
Mailing address:
  • Phone: 410-571-8733
  • Fax: 410-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS013230
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: