MEDICARE: DR. ANITA BOYD BENNETT M.D.

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
1	207QA0505X	Adult Medicine Physician	044628	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CSP.0046239	OTHER	CT	STATE OF CT CONTROLLED SUBSTANCE REGISTRATION

General Provider Information

NPI Number	:	1598098881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA BOYD BENNETT M.D.

Provider Business Mailing Address
First Line	:	1249 BOULEVARD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1603
Country	:	US
Telephone Number	:	860-216-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 BOULEVARD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1603
Country	:	US
Telephone Number	:	860-216-5442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	03/07/2023

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