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General NPI Number Information
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NPI Number | 1598946006
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Entity Type | Individual
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Provider Name | JUSTINA A BENNETT PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 85 THOMAS JOHNSON CT, SUITE C INTERNAL MEDICINE SPECIALISTS OF FREDERICK
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City | FREDERICK
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State | MD
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Zip | 21702
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Country | US
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Telephone | 301-668-9393
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Fax | 301-668-4480
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Provider Business Mailing Address
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Address Line | 85 THOMAS JOHNSON CT, SUITE C
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City | FREDERICK
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State | MD
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Zip | 21702
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Country | US
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Telephone | 301-668-9393
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Fax | 301-668-4480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C03652
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0003652
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License Number State | MD
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