Provider Demographics
NPI:1942226709
Name:BENNETT, IRWIN KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:KENNETH
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 1:94 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2123
Mailing Address - Country:US
Mailing Address - Phone:508-947-6100
Mailing Address - Fax:508-947-6811
Practice Address - Street 1:94 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2123
Practice Address - Country:US
Practice Address - Phone:508-947-6100
Practice Address - Fax:508-947-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD076592084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry