# BBENNETTMD 1 ON 1 VIRTUAL HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407470107
- **Authorized official:** ELIZABETH ANN BENNETT MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (571) 749-8420

## Contact information

- **Practice address:** 9159 BLOOM CT, BURKE, VA 22015-1643
- **Practice address phone:** (571) 749-8420
- **Practice address fax:** (855) 955-0445
- **Mailing address:** 9159 BLOOM CT, BURKE, VA 22015-1643
- **Mailing address phone:** (571) 749-8420
- **Mailing address fax:** (855) 955-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/29/2020
- **Last updated:** 11/07/2021