Healthcare Provider Details

I. General information

NPI: 1962440628
Provider Name (Legal Business Name): LAVERN K BENTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW HUH B105
WASHINGTON DC
20060-2306
US

IV. Provider business mailing address

7611 MAPLE AVE #407
TAKOMA PARK MD
20912-5559
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax: 202-865-6713
Mailing address:
  • Phone: 202-378-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number240118
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: