Provider Demographics
NPI:1598385353
Name:HELFGOTT, BENNET M
Entity Type:Individual
Prefix:
First Name:BENNET
Middle Name:M
Last Name:HELFGOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 SUMMER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-3922
Mailing Address - Country:US
Mailing Address - Phone:703-772-5030
Mailing Address - Fax:571-378-1093
Practice Address - Street 1:5586 GENERAL WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2465
Practice Address - Country:US
Practice Address - Phone:703-772-5030
Practice Address - Fax:571-378-1093
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist