Provider Demographics
NPI:1376819524
Name:BENNETT, GREGORY HAYWARD (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:HAYWARD
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 FISHINGER BLVD.
Mailing Address - Street 2:STE. 280
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7801
Mailing Address - Country:US
Mailing Address - Phone:614-758-7600
Mailing Address - Fax:614-758-7609
Practice Address - Street 1:3535 FISHINGER BLVD.
Practice Address - Street 2:STE. 280
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7801
Practice Address - Country:US
Practice Address - Phone:614-758-7600
Practice Address - Fax:614-758-7609
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40614207K00000X
OH34.014935207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology