Healthcare Provider Details

I. General information

NPI: 1649707795
Provider Name (Legal Business Name): RACHEL MACKENZIE BENNETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 07/27/2022
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4119
  • Fax:
Mailing address:
  • Phone: 203-785-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64904
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMT224391
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: