Provider Demographics
NPI:1710503230
Name:BENNETT, ALAN HUGH (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:HUGH
Last Name:BENNETT
Suffix:
Gender:M
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:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-0569
Mailing Address - Country:US
Mailing Address - Phone:201-618-7093
Mailing Address - Fax:603-397-5585
Practice Address - Street 1:592 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:RAQUETTE LAKE
Practice Address - State:NY
Practice Address - Zip Code:13436-1907
Practice Address - Country:US
Practice Address - Phone:315-354-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138178208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology