Provider Demographics
NPI:1801828934
Name:BENDECK, CARL ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ERIC
Last Name:BENDECK
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 1:2000 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4627
Mailing Address - Country:US
Mailing Address - Phone:423-857-5905
Mailing Address - Fax:423-857-5904
Practice Address - Street 1:2000 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4627
Practice Address - Country:US
Practice Address - Phone:423-857-5905
Practice Address - Fax:423-857-5904
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38000321Medicaid
TNQ002681Medicaid
TNP00886934OtherRAILROAD MEDICARE
NC5912846Medicaid
KY7100040190Medicaid
TN1516316Medicaid
VA1801828934Medicaid
KY7100040190Medicaid