Provider Demographics
NPI:1003179318
Name:BENNETT, WILLIAM RODERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RODERIC
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEXINGTON RD
Mailing Address - Street 2:BLDG 100
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1276
Mailing Address - Country:US
Mailing Address - Phone:856-467-7360
Mailing Address - Fax:
Practice Address - Street 1:100 LEXINGTON RD
Practice Address - Street 2:BLDG 100
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1276
Practice Address - Country:US
Practice Address - Phone:856-467-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09586800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine