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NPI Code Detail

MEDICARE: DR. ANGELA M BENNETT M.D.

MEDICARE: DR. ANGELA M 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
1207Q00000XFamily Medicine Physician35-088523OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14203042OTHEROHMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861495236
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA M BENNETT M.D.
Provider Business Mailing Address
First Line : 5264 LEE RD
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-1232
Country : US
Telephone Number : 216-294-4440
Fax Number : 216-249-6032
Provider Business Practice Location Address
First Line : 5264 LEE RD
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-1232
Country : US
Telephone Number : 216-294-4440
Fax Number : 216-249-6032
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 08/25/2023

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