Provider Demographics
NPI:1548397920
Name:GAEV, BENNETT N (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:N
Last Name:GAEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:167 DWIGHT RD # 104
Mailing Address - Street 2:THERAPEUTIC ASSOCIATES PC
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01108
Mailing Address - Country:US
Mailing Address - Phone:413-567-5533
Mailing Address - Fax:413-567-9010
Practice Address - Street 1:167 DWIGHT RD # 104
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-567-5533
Practice Address - Fax:413-567-9010
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA765922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y01990Medicare ID - Type Unspecified
A55320Medicare UPIN