MEDICARE: DR. ERNEST A BENEDETTO 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	207ND0101X	MOHS-Micrographic Surgery Physician	MD041498L	PA

General Provider Information

NPI Number	:	1538100540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST A BENEDETTO M.D.

Provider Business Mailing Address
First Line	:	1200 LOCUST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5605
Country	:	US
Telephone Number	:	215-546-3666
Fax Number	:	215-546-6060

Provider Business Practice Location Address
First Line	:	1200 LOCUST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5605
Country	:	US
Telephone Number	:	215-546-3666
Fax Number	:	215-546-6060

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	12/06/2010

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