Healthcare Provider Details

I. General information

NPI: 1538846027
Provider Name (Legal Business Name): DAMON BENNETT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAMON BENNETT NP

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD STE 162
BALTIMORE MD
21228-4646
US

IV. Provider business mailing address

405 FREDERICK RD
BALTIMORE MD
21228-4645
US

V. Phone/Fax

Practice location:
  • Phone: 443-637-1002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR235159
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR235159
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: