Healthcare Provider Details

I. General information

NPI: 1558433755
Provider Name (Legal Business Name): BENNINGTON ASSOCIATES IN INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 DEWEY ST
BENNINGTON VT
05201-2253
US

IV. Provider business mailing address

339 DEWEY ST
BENNINGTON VT
05201-2253
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-8164
  • Fax: 802-442-4214
Mailing address:
  • Phone: 802-442-8164
  • Fax: 802-442-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BETSEY WALTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-442-8164