Provider Demographics
NPI:1164414280
Name:LOCKETT-BENJAMIN, TAMMY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:M
Last Name:LOCKETT-BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13880 BRADDOCK RD
Mailing Address - Street 2:STE 307
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2459
Mailing Address - Country:US
Mailing Address - Phone:703-968-0015
Mailing Address - Fax:703-968-0017
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:STE 307
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2459
Practice Address - Country:US
Practice Address - Phone:703-968-0015
Practice Address - Fax:703-968-0017
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237687207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology