MEDICARE: DR. SOPHIA MAE EDWARDS-BENNETT MD, PH.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	2085R0001X	Radiation Oncology Physician	34473	WV
2	2085R0001X	Radiation Oncology Physician	ME108066	FL
3	2085R0001X	Radiation Oncology Physician	MD34483	SC
4	2085R0203X	Therapeutic Radiology Physician	24405-1	NY
5	2085R0001X	Radiation Oncology Physician	TL34483	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P01070951	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	80023852	OTHER	SC	SELECT HEALTH
3	4952170	OTHER	SC	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	9322600	OTHER	SC	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	692677	OTHER	SC	WELLCARE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942468426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA MAE EDWARDS-BENNETT MD, PH.D

Provider Business Mailing Address
First Line	:	1340 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3804
Country	:	US
Telephone Number	:	304-399-6500
Fax Number	:	304-399-6621

Provider Business Practice Location Address
First Line	:	1400 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-4114
Country	:	US
Telephone Number	:	304-399-6500
Fax Number	:	304-399-6621

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/19/2026

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