Provider Demographics
NPI:1508070376
Name:BORNSTEIN BENNETT, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BORNSTEIN 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 1:175 NATE WHIPPLE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1422
Mailing Address - Country:US
Mailing Address - Phone:401-334-5437
Mailing Address - Fax:401-334-3571
Practice Address - Street 1:175 NATE WHIPPLE HWY STE 102
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1422
Practice Address - Country:US
Practice Address - Phone:401-334-5437
Practice Address - Fax:401-334-3571
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD123012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD12301OtherSTATE LICENSE NUMBER