Provider Demographics
NPI:1093077356
Name:ADDICOTT, BENJAMIN TEICHMAN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TEICHMAN
Last Name:ADDICOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BATH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5322
Mailing Address - Country:US
Mailing Address - Phone:805-682-7984
Mailing Address - Fax:
Practice Address - Street 1:17161 FRIML LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4510
Practice Address - Country:US
Practice Address - Phone:352-262-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1543482085R0202X
OH351499792085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology