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NPI Code Detail

MEDICARE: JESSICA BENESCH HAZEN D.O.

MEDICARE: JESSICA BENESCH HAZEN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1194998419
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BENESCH HAZEN D.O.
Provider Business Mailing Address
First Line : 27 E MOUNT AIRY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-1713
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 27 E MOUNT AIRY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-1713
Country : US
Telephone Number : 215-248-6826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2008
Last Update Date : 11/30/2021

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Directions to “ JESSICA BENESCH HAZEN D.O.” Practice Location

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