Provider Demographics
NPI:1982876868
Name:BENNETT, ZELDA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ZELDA
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ZELDA
Other - Middle Name:MARIE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2818 VICEROY AVE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3213
Mailing Address - Country:US
Mailing Address - Phone:240-838-3714
Mailing Address - Fax:301-277-7273
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:301-433-9147
Practice Address - Fax:301-434-9178
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC002404363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical