Healthcare Provider Details

I. General information

NPI: 1861457129
Provider Name (Legal Business Name): WARD E BENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM ST SUITE 1200
RALEIGH NC
27617-8221
US

IV. Provider business mailing address

PO BOX 751274
CHARLOTTE NC
28275-1274
US

V. Phone/Fax

Practice location:
  • Phone: 919-206-4889
  • Fax: 919-206-4875
Mailing address:
  • Phone: 919-620-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9300032
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: