Provider Demographics
NPI:1821053026
Name:BENNETT, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:85 BRYANT WOODS S
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3604
Mailing Address - Country:US
Mailing Address - Phone:716-689-3333
Mailing Address - Fax:716-689-9695
Practice Address - Street 1:240 RED TAIL
Practice Address - Street 2:SUITE 8
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1581
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:716-689-9695
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205602-12084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020025801OtherUNIVERA
NY1508963OtherIHA
NY161000580OtherEMPIRE
NY185386OtherCOMPSYCH
NY205602-6WOtherWORKERS COMPENSATION
NY000524673001OtherHEALTH NOW
NY161000580OtherNORTH AMERICAN PREFERRED
NY161000580OtherUNITED BEHAVIORAL HEALTH
NY01735506Medicaid
NY00020025801OtherUNIVERA
NY161000580OtherUNITED BEHAVIORAL HEALTH