Provider Demographics
NPI:1083682983
Name:BENTLEY, JODY B (DO)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:B
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:96 15TH ST NW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1625
Mailing Address - Country:US
Mailing Address - Phone:276-439-1860
Mailing Address - Fax:276-439-1865
Practice Address - Street 1:96 15TH ST NW
Practice Address - Street 2:SUITE 111
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1625
Practice Address - Country:US
Practice Address - Phone:276-439-1860
Practice Address - Fax:276-439-1865
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00689801OtherRR MEDICARE
VA1083682983Medicaid
KY7100063400Medicaid
P00689801OtherRR MEDICARE
VA00X674N04Medicare PIN