Provider Demographics
NPI:1598898934
Name:ABDEL-MISIH/BENNETT, MDS, PA
Entity Type:Organization
Organization Name:ABDEL-MISIH/BENNETT, MDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAFAT
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ABDEL-MISIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-658-7533
Mailing Address - Street 1:4701 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2055
Mailing Address - Country:US
Mailing Address - Phone:302-658-7533
Mailing Address - Fax:
Practice Address - Street 1:4701 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 4000
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2055
Practice Address - Country:US
Practice Address - Phone:302-658-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE221604292OtherBLUE SHIELD OF DELAWARE
DEG02046Medicare ID - Type UnspecifiedGENERAL SURGEON