1114907219 NPI number — MARK A BENNETT M.D.

Table of content: MARK A BENNETT M.D. (NPI 1114907219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114907219 NPI number — MARK A BENNETT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114907219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-0137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-270-2717
Provider Business Mailing Address Fax Number:
610-270-2675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 POWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-270-2717
Provider Business Practice Location Address Fax Number:
610-270-2675
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD051325L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: MD051325L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01479660 . This is a "AMERICHOICE(UHC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD051325L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0724619000 . This is a "IBC - PC, KHPE, AMERIHEAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5981601 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8439971 . This is a "CIGNA HMO/PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001479660 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2443406 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 050065882 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 190060 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9061010 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1099349 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0724619000 . This is a "AMERIHEALTH/INTERCOUNTY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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