MEDICARE: DR. KARL T. BENEDICT III M.D.

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
1	207R00000X	Internal Medicine Physician	MD-061493-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215955448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL T. BENEDICT III M.D.

Provider Business Mailing Address
First Line	:	615 CHESTNUT ST
Second Line	:	14TH FLOOR, CENTRAL ENROLLMENT
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4310
Country	:	US
Telephone Number	:	215-551-8660
Fax Number	:	215-551-9247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/23/2014

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