Basic Information
| Provider Information | |||||||||
| NPI: | 1225220320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIGMOND | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., C.W.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1703 INNOVATION DR STE 3136 | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174088815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177413449 | ||||||||
| FaxNumber: | 7177415496 | ||||||||
| Practice Location | |||||||||
| Address1: | 2494 BERNVILLE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103787900 | ||||||||
| FaxNumber: | 6103781952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | P0497 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 35099820 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD427801 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0076920 | 05 | OH | MEDICAID |