MEDICARE: MR. NICHOLAS NATHANIEL BENNETT

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	207X00000X	Orthopaedic Surgery Physician	OT020991	PA

General Provider Information

NPI Number	:	1912585183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS NATHANIEL BENNETT

Provider Business Mailing Address
First Line	:	4190 CITY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4190 CITY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1626
Country	:	US
Telephone Number	:	215-871-6926
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/15/2026

Similar Medicare Providers

1659371847 — LARRY N. FINKELSTEIN DO
Practice Location Address:

4190 CITY AVE
PHILADELPHIA, PA
19131-1626

Practice Phone: 215-871-6380
Practice Fax: 215-871-6381

1649271313 — JOHN M. CAVENAGH PA
Practice Location Address:

4190 CITY LINE AVE , SUITE 315
PHILADELPHIA, PA
19131-1626

Practice Phone: 215-871-6380
Practice Fax: 215-871-6381

1336140979 — KATHERINE E. GALLUZZI DO
Practice Location Address:

4190 CITY AVE , SUITE 315
PHILADELPHIA, PA
19131-1626

Practice Phone: 215-871-6844
Practice Fax: 215-871-6932

1477554541 — JOHN P. SIMELARO DO
Practice Location Address:

4190 CITY AVE , SUITE 315
PHILADELPHIA, PA
19131-1626

Practice Phone: 215-871-6337
Practice Fax: 215-871-6347

1104827286 — KENNETH J. VEIT DO
Practice Location Address:

4190 CITY LINE AVE
PHILADELPHIA, PA
19131-1626

Practice Phone: 215-871-6380
Practice Fax: 215-871-6381

1700887858 — TODD D. VLADYKA DO
Practice Location Address:

4190 CITY LINE AVE , SUITE 100
PHILADELPHIA, PA
19131-1626

Practice Phone: 215-871-6380
Practice Fax: 215-871-6381

Directions to “ MR. NICHOLAS NATHANIEL BENNETT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.