Healthcare Provider Details

I. General information

NPI: 1942468426
Provider Name (Legal Business Name): SOPHIA MAE EDWARDS-BENNETT MD, PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

IV. Provider business mailing address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3804
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-6500
  • Fax: 304-399-6621
Mailing address:
  • Phone: 304-399-6500
  • Fax: 304-399-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberTL34483
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME108066
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD34483
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number24405-1
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number34473
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: