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General NPI Number Information
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NPI Number | 1093077356
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Entity Type | Individual
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Provider Name | BENJAMIN TEICHMAN ADDICOTT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 17161 FRIML LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-4510
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Country | US
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Telephone | 352-262-1784
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 BATH ST STE 208
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City | SANTA BARBARA
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State | CA
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Zip | 93105-5322
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Country | US
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Telephone | 805-682-7984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A154348
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 35149979
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License Number State | OH
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