Provider Demographics
NPI:1205896776
Name:HENDRICKS, CAROLYN BENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BENNETT
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 506
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-897-1503
Mailing Address - Fax:301-581-0254
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 506
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-897-1503
Practice Address - Fax:301-581-0254
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1212579OtherUNITED HEALTHCARE
MD4318989OtherAETNA PPO
MD470CCBOtherCARE FIRST BCBS
DCN060OtherBCBS NCA/FEP
MD1210366OtherAETNA HMO
MD670109OtherMAMSI/MDIPA/OPTIMUM CH
MD1210366OtherAETNA HMO
MD1212579OtherUNITED HEALTHCARE