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General NPI Number Information
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NPI Number | 1316628423
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Entity Type | Individual
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Provider Name | GRACE BENNFORS
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 OLD YORK ROAD KLEIN BUILDING, SUITE 510
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City | PHILADELPHIA
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State | PA
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Zip | 19141
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Country | US
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Telephone | 215-456-3443
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL92785
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT235026
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License Number State | PA
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