Provider Demographics
NPI:1598098881
Name:BENNETT, ANITA BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:BOYD
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 1:1249 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1603
Mailing Address - Country:US
Mailing Address - Phone:860-216-5442
Mailing Address - Fax:
Practice Address - Street 1:1249 BOULEVARD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1603
Practice Address - Country:US
Practice Address - Phone:860-216-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044628207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCSP.0046239OtherSTATE OF CT CONTROLLED SUBSTANCE REGISTRATION
CTCSP.0046239OtherSTATE OF CT CONTROLLED SUBSTANCE REGISTRATION