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NPI Code Detail

MEDICARE: JOEL ALAN BENNETT M.D.

MEDICARE: JOEL ALAN BENNETT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician0101058456VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
133888OTHERVACARENET

General Provider Information

NPI Number : 1588668420
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL ALAN BENNETT M.D.
Provider Business Mailing Address
First Line : 10800 MIDLOTHIAN TPKE
Second Line : SUITE 265
City : RICHMOND
State : VA
Zip : 23235-4724
Country : US
Telephone Number : 804-594-2622
Fax Number : 804-594-0915
Provider Business Practice Location Address
First Line : 10800 MIDLOTHIAN TPKE
Second Line : SUITE 265
City : RICHMOND
State : VA
Zip : 23235-4724
Country : US
Telephone Number : 804-594-2622
Fax Number : 804-594-0915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 12/06/2007

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