Provider Demographics
NPI:1861446700
Name:BENNETT, RICHARD H (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3030
Mailing Address - Country:US
Mailing Address - Phone:215-324-3300
Mailing Address - Fax:215-324-6150
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:SUITE 405
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3046
Practice Address - Country:US
Practice Address - Phone:215-324-3300
Practice Address - Fax:215-324-6150
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017871E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD68752Medicare UPIN