Provider Demographics
NPI:1669471678
Name:BENNETT, KERRY G (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:G
Last Name:BENNETT
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-368-3190
Mailing Address - Fax:508-368-3193
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3190
Practice Address - Fax:508-368-3193
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-02-18
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Provider Licenses
StateLicense IDTaxonomies
MA161131208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110034723AMedicaid
H09642Medicare UPIN
MAA3053805Medicare PIN