1447233283 NPI number — DR. GEORGE JESSE BENDER III M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447233283 NPI number — DR. GEORGE JESSE BENDER III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENDER
Provider First Name:
GEORGE
Provider Middle Name:
JESSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
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:
1447233283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 VANDERBILT PARK DR
Provider Second Line Business Mailing Address:
MEMORIAL HOSPITAL OF RHODE ISLAND
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-729-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BREWSTER STREET
Provider Second Line Business Practice Location Address:
MEMORIAL HOSPITAL OF RHODE ISLAND
Provider Business Practice Location Address City Name:
PAWTUCKER
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-729-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2005

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: 2080N0001X , with the licence number:  MD11211 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GB51684 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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