1821039496 NPI number — DR. ROBERT MACINTYRE BENNETT M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821039496 NPI number — DR. ROBERT MACINTYRE BENNETT M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BENNETT

Provider First Name:

ROBERT

Provider Middle Name:

MACINTYRE

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1821039496

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/30/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

8001 FRANKLIN FARMS DR

Provider Second Line Business Mailing Address:

SUITE 130

Provider Business Mailing Address City Name:

RICHMOND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23229-5108

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-521-5800

Provider Business Mailing Address Fax Number:

804-545-4340

Provider First Line Business Practice Location Address:

658 HOSPITAL RD

Provider Second Line Business Practice Location Address:

SUITE 302

Provider Business Practice Location Address City Name:

TAPPAHANNOCK

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22560-5000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-443-6235

Provider Business Practice Location Address Fax Number:

804-443-6239

Provider Enumeration Date:

06/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  0101024513 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 5102802 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1432711 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4063276 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 103789 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 3257137 . This is a "AETNA US HEALTHCARE HMO" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
• Identifier: 72764 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 463048 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 010009120 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 296195 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 27413300 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: P00029402 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".