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NPI Code Detail

MEDICARE: DR. IRWIN KENNETH BENNETT MD

MEDICARE: DR. IRWIN KENNETH 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
12084P0804XChild & Adolescent Psychiatry PhysicianMD07659RI

General Provider Information

NPI Number : 1942226709
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IRWIN KENNETH BENNETT MD
Provider Business Mailing Address
First Line : 94 S MAIN ST
Second Line :
City : MIDDLEBORO
State : MA
Zip : 02346-2123
Country : US
Telephone Number : 508-947-6100
Fax Number : 508-947-6811
Provider Business Practice Location Address
First Line : 94 S MAIN ST
Second Line :
City : MIDDLEBORO
State : MA
Zip : 02346-2123
Country : US
Telephone Number : 508-947-6100
Fax Number : 508-947-6811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 04/03/2012

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