Provider Demographics
NPI:1467989079
Name:BENNETT, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FAIRFAX AVENUE
Mailing Address - Street 2:SUITE 528
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-2012
Mailing Address - Country:US
Mailing Address - Phone:757-446-7979
Mailing Address - Fax:757-446-8907
Practice Address - Street 1:825 FAIRFAX AVENUE
Practice Address - Street 2:SUITE 528
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2012
Practice Address - Country:US
Practice Address - Phone:757-446-7979
Practice Address - Fax:757-446-8907
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231807207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics