Benjamin Materi Jackson
Surgeon Vascular Surgeon
3400 Spruce Street 4 Silverstein Building
Philadelphia
, Pennsylvania 19104-4206
Benjamin Materi Jackson
Surgeon Vascular Surgeon
3400 Spruce Street 4 Silverstein Building
Philadelphia
, Pennsylvania 19104-4206
(215) 615-4949
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About
Features
Specialties
- Surgeon
- Vascular Surgeon
Languages spoken
- English
Location
First Address
- Benjamin Materi Jackson
- 3400 Spruce Street 4 Silverstein Building
- Philadelphia, PA
- Zip : 19104-4206
- Phone : (215) 615-4949
Second Address
- Benjamin Materi Jackson
- 3400 Spruce Street 4 Silverstein Building
- Philadelphia, PA
- Zip : 19104-4206
- Phone : (215) 615-4949
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 208200000X | Surgeon | MD420325 | PA |
| N | 208600000X | Surgeon | MD420325 | PA |
| Y | 2086S0129X | Vascular Surgeon | MD420325 | PA |
| N | 2086S0129X | Vascular Surgeon | MT047810T | PA |
National Provider Identifier
| NPI | 1164588448 |
|---|---|
| Provider Name | Benjamin Materi Jackson |
| First Address | Philadelphia, PA 19104-4206 |
| Second Address | Philadelphia, PA 19104-4206 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/12/2006 |
| Last Update Date | 04/04/2012 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.