Provider Demographics
NPI:1144227885
Name:BENNETT, SARITA L (DO)
Entity Type:Individual
Prefix:DR
First Name:SARITA
Middle Name:L
Last Name:BENNETT
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:RR 2 BOX 386
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-9743
Mailing Address - Country:US
Mailing Address - Phone:304-799-0011
Mailing Address - Fax:304-799-0035
Practice Address - Street 1:RR 2 BOX 386
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954-9743
Practice Address - Country:US
Practice Address - Phone:304-799-0011
Practice Address - Fax:304-799-0035
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5600573000Medicaid
WV4902001000Medicaid
WV4902001001Medicaid
WV2031551Medicare PIN
WV2031556Medicare PIN
WV4902001001Medicaid
WV2031554Medicare PIN
WVWV1755Medicare UPIN
WV2031552Medicare PIN
WV2031555Medicare PIN
WV2031557Medicare PIN