NPIMap

Organization Active NPI

Benedetto Dermatology, LLC

  • MOHS-Micrographic Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1972771129
Registry record updated Dec 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
207ND0101X Issued in PA
Legal business name
BENEDETTO DERMATOLOGY, LLC
Practice address
1200 Locust St
Philadelphia, PA 19107-5605
Phone
(215) 546-3666
Fax
(215) 546-6060
NPI assigned
Feb 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anthony V Benedetto, D.O.NPI 1831154871
Title
Medical Director
Phone
(215) 546-3666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X 207ND0101X PA Primary

Addresses

Primary practice location

1200 Locust St
Philadelphia, PA 19107-5605

Mailing address

1200 Locust St
Philadelphia, PA 19107-5605
Phone (215) 546-3666

Other identifiers 2

IdentifierTypeStateIssuer
101750OtherPAHIGHMARK BLUE SHIELD
0274011000OtherPAINDEPENDENCE BLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150109001248 PA Part B Supplier - Clinic/Group Practice 4880918390 Receives reassigned benefits from 6 practitioners
Practice locations: Philadelphia, PA; Drexel Hill, PA

National Provider Directory

National Provider Directory

Locations

2221 Garrett Rd
Drexel Hill, PA 19026
Phone (610) 623-5885

1200 Locust St
Fl 1
Phila, PA 19107
Phone (215) 663-8200

1200 Locust St
Philadelphia, PA 19107
Phone (215) 546-3666

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1972771129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 LOCUST ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075605",
            "telephone_number": "215-546-3666",
            "fax_number": "215-546-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 LOCUST ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075605",
            "telephone_number": "215-546-3666",
            "fax_number": "215-546-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEDETTO DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "BENEDETTO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "215-546-3666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "207ND0101X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "101750",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0274011000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.