Provider Demographics
NPI:1104813468
Name:BENZ, JEROME V (DO)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:V
Last Name:BENZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:1880 KENNETH RD STE 1
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-6344
Practice Address - Country:US
Practice Address - Phone:717-767-2000
Practice Address - Fax:717-767-2013
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2025-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013230207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07734340Medicaid
PA07734340Medicaid
PA086774PWHMedicare ID - Type Unspecified