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General NPI Number Information
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NPI Number | 1710503230
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Entity Type | Individual
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Provider Name | ALAN HUGH BENNETT MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2020
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Last Update Date | 06/20/2020
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Provider Practice Location Address
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Address Line | 592 STATE ROUTE 28
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City | RAQUETTE LAKE
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State | NY
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Zip | 13436-1907
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Country | US
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Telephone | 315-354-4151
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX D
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City | NEWMARKET
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State | NH
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Zip | 03857-0569
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Country | US
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Telephone | 201-618-7093
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Fax | 603-397-5585
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 138178
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License Number State | NY
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