Provider Demographics
NPI:1730179813
Name:STANGER, BEN Z (MD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:Z
Last Name:STANGER
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 1:3400 CIVIC CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:215-349-8222
Mailing Address - Fax:215-662-6530
Practice Address - Street 1:3400 CIVIC CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-349-8222
Practice Address - Fax:215-662-6530
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207642207R00000X, 207RG0100X
PAMD429940207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA207642OtherTUFTS HEALTH PLAN
MAJ25863OtherBCBS MA
MA2003783Medicaid
MA207642OtherTUFTS HEALTH PLAN
MA2003783Medicaid
PA109972Medicare PIN