1003813981 NPI number — DR. ARLENE P BENNETT MD

Table of content: DR. ARLENE P BENNETT MD (NPI 1003813981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813981 NPI number — DR. ARLENE P BENNETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
ARLENE
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1003813981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1016 BETHLEHEM PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERDENHEIM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19038-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-233-2333
Provider Business Mailing Address Fax Number:
215-233-5371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1016 BETHLEHEM PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERDENHEIM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-7703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-233-2333
Provider Business Practice Location Address Fax Number:
215-233-5371
Provider Enumeration Date:
07/07/2005

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: 2084P0800X , with the licence number:  MD029319L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: #0070526170002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1C 101871 . This is a "HIGHMARK MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2834801000 . This is a "PERSONAL CHOICE & KEYSTON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 99715 . This is a "CBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2834801000 . This is a "IBX" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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