Healthcare Provider Details

I. General information

NPI: 1285709436
Provider Name (Legal Business Name): RICARDO M. BENNETT DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LEE HWY SUITE 303
ARLINGTON VA
22207-1619
US

IV. Provider business mailing address

5275 LEE HWY SUITE 303
ARLINGTON VA
22207-1619
US

V. Phone/Fax

Practice location:
  • Phone: 703-538-5111
  • Fax: 703-538-4193
Mailing address:
  • Phone: 703-538-5111
  • Fax: 703-538-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateVA

VIII. Authorized Official

Name: RICARDO BENNETT
Title or Position: DOCTOR
Credential: D.P.M.
Phone: 703-538-5111