MEDICARE: DR. WARD E BENNETT 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
1	207Q00000X	Family Medicine Physician	9300032	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1861457129	OTHER	NC	NPI
2	1952335184	OTHER	NC	LOCATION NPI

General Provider Information

NPI Number	:	1861457129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARD E BENNETT MD

Provider Business Mailing Address
First Line	:	PO BOX 751274
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1274
Country	:	US
Telephone Number	:	919-620-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	10211 ALM ST
Second Line	:	SUITE 1200
City	:	RALEIGH
State	:	NC
Zip	:	27617-8221
Country	:	US
Telephone Number	:	919-206-4889
Fax Number	:	919-206-4875

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	04/30/2013

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