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NPI Code Detail

MEDICARE: MS. ANGELA J BENNETT P.A.-C

MEDICARE: MS. ANGELA J BENNETT P.A.-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant50002465OH

General Provider Information

NPI Number : 1376555961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA J BENNETT P.A.-C
Provider Business Mailing Address
First Line : 935 STATE ROUTE 28
Second Line :
City : MILFORD
State : OH
Zip : 45150-1957
Country : US
Telephone Number : 513-831-5955
Fax Number :
Provider Business Practice Location Address
First Line : 935 STATE ROUTE 28
Second Line :
City : MILFORD
State : OH
Zip : 45150-1957
Country : US
Telephone Number : 513-831-5955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 04/03/2017

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