Provider Demographics
NPI:1982635447
Name:BENJAMIN, CHARLES DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1335 W TABOR RD
Mailing Address - Street 2:SUITE 201-202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3038
Mailing Address - Country:US
Mailing Address - Phone:215-424-0222
Mailing Address - Fax:215-424-9860
Practice Address - Street 1:1335 W TABOR RD
Practice Address - Street 2:SUITE 201-202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3038
Practice Address - Country:US
Practice Address - Phone:215-424-0222
Practice Address - Fax:215-424-9860
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003378L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology