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General NPI Number Information
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NPI Number | 1639745458
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Entity Type | Individual
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Provider Name | BENNETT KOBITZ CSA, CST
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Gender | Male
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1701 TWIN SPRINGS RD
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City | HALETHORPE
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State | MD
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Zip | 21227-3553
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Country | US
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Telephone | 410-737-5720
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Fax |
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Provider Business Mailing Address
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Address Line | 7656 OLD ROCKBRIDGE DR
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City | ELKRIDGE
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State | MD
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Zip | 21075-6166
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Country | US
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Telephone | 831-359-1859
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Fax |
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | ST.0005969
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA.0002781
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License Number State | CO
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