Healthcare Provider Details

I. General information

NPI: 1053482141
Provider Name (Legal Business Name): DONALD RICHARD BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

6022 STONEHENGE PL
NORTH BETHESDA MD
20852-5800
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-2552
  • Fax: 301-295-2662
Mailing address:
  • Phone: 301-816-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0070559
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01047400A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0104700A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME124502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: