Provider Demographics
NPI:1467429415
Name:BENNETT, OLIVER MOSES (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:MOSES
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4003
Mailing Address - Country:US
Mailing Address - Phone:301-562-7764
Mailing Address - Fax:301-562-0884
Practice Address - Street 1:1111 SPRING ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:301-562-7764
Practice Address - Fax:301-562-0884
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine