Provider Demographics
NPI:1326046145
Name:BENTSEN, ISABELLA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:D
Last Name:BENTSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ISABELLA
Other - Middle Name:D
Other - Last Name:VASSILEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5920 SANDY FORKS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3814
Mailing Address - Country:US
Mailing Address - Phone:919-845-2125
Mailing Address - Fax:919-845-2152
Practice Address - Street 1:5920 SANDY FORKS RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3814
Practice Address - Country:US
Practice Address - Phone:919-845-2125
Practice Address - Fax:919-845-2152
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001001150207R00000X
NC2001-01150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH38837Medicare UPIN