Provider Demographics
NPI:1518015296
Name:ALFORD, BENNETT A (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:A
Last Name:ALFORD
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UVA HOSPITAL
Practice Address - Street 2:LEE STREET, 1ST FLOOR
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:804-924-2781
Practice Address - Fax:434-982-1618
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010282332085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7200200Medicaid
VACO2270Medicare PIN
VA7200200Medicaid
VA300000425Medicare PIN