Provider Demographics
NPI:1134136435
Name:BENNING, KATHLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BENNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherTRICARE
MA110089181AOtherMEDICAID
1134136435OtherFALLON
042297845OtherHVMA/FIRST HEALTH/COVENTRY
042297845OtherPHCS/MULTI-PLAN
AA217699OtherHARVARD PILGRIM
04-2297845OtherUNITED HEALTH CARE
042297845OtherUNITED HEALTH CARE
769190OtherTUFTS AND TUFTS MEDICARE PREFERRED
0816728OtherCIGNA
MAJ49047OtherBCBSMA
042297845OtherGIV/UNICARE
1134136435OtherNHP
0816728OtherCIGNA
04-2297845OtherUNITED HEALTH CARE