=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104362953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY M BENTLEY MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2017
-----------------------------------------------------
Last Update Date | 04/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 HIGHLAND AVE SUITE 7
-----------------------------------------------------
City | NEWBURYPORT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01950-3872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-465-8000
-----------------------------------------------------
Fax | 978-465-2903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 HIGHLAND AVE SUITE 7
-----------------------------------------------------
City | NEWBURYPORT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01950-3872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-465-8000
-----------------------------------------------------
Fax | 978-465-2903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL SURGEON
-----------------------------------------------------
Name | DR. JEFFREY MARK BENTLEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 978-465-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 51246
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------