Provider Demographics
NPI:1033265848
Name:FEIN, BENNETT IRA (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:IRA
Last Name:FEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 HOSPITAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1929
Mailing Address - Country:US
Mailing Address - Phone:276-666-0044
Mailing Address - Fax:276-666-0393
Practice Address - Street 1:319 HOSPITAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1929
Practice Address - Country:US
Practice Address - Phone:276-666-0044
Practice Address - Fax:276-666-0393
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401498207RG0100X
VA0101243894207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033265848Medicaid
NC5900806Medicaid
E56359Medicare UPIN
NC5900806Medicaid