Provider Demographics
NPI:1942271374
Name:BENNETT, ROBERT CAMPBELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CAMPBELL
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 1:8166 MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6262
Mailing Address - Country:US
Mailing Address - Phone:330-953-3242
Mailing Address - Fax:330-953-3243
Practice Address - Street 1:1044 BELMONT AVE.
Practice Address - Street 2:PATHOLOGY CONSULTANTS-CREDENTIALING
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44501-1790
Practice Address - Country:US
Practice Address - Phone:330-480-3768
Practice Address - Fax:330-480-2062
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-5105-B207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922827Medicaid
OH0922827Medicaid
OHBE0740191Medicare ID - Type Unspecified