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NPI Code Detail

MEDICARE: BENNETT HASKIN TEAL MD

MEDICARE: BENNETT HASKIN TEAL MD
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
1207Q00000XFamily Medicine Physician84208SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427677053
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENNETT HASKIN TEAL MD
Provider Business Mailing Address
First Line : 300 SINGLETON RIDGE RD
Second Line : ATTENTION PNS CREDENTIALING
City : CONWAY
State : SC
Zip : 29526-9142
Country : US
Telephone Number : 843-234-6946
Fax Number :
Provider Business Practice Location Address
First Line : 1301 CREEL ST
Second Line :
City : CONWAY
State : SC
Zip : 29527-5018
Country : US
Telephone Number : 843-248-4414
Fax Number : 843-248-3781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2020
Last Update Date : 05/10/2024

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Directions to “ BENNETT HASKIN TEAL MD” Practice Location

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