Provider Demographics
NPI:1801884341
Name:BENNETT, PAUL SCOTT (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0002
Mailing Address - Country:US
Mailing Address - Phone:336-226-0660
Mailing Address - Fax:336-227-6327
Practice Address - Street 1:4030 OAKS PROFESSIONAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8491
Practice Address - Country:US
Practice Address - Phone:336-226-0660
Practice Address - Fax:336-227-6327
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800191207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11358OtherBCBS
263050OtherWELLPATH
24244OtherMEDICARE PARTNERS
NC891127UMedicaid
G67820OtherMAMSI
3681525OtherCIGNA
P00226808OtherRAILROAD MEDICARE
NC1000405OtherUNITED HEALTHCARE
D9835OtherMEDCOST
G67820Medicare UPIN
NC891127UMedicaid