Individual
ANDREW ERNEST BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
55 LAKE AVE NORTH, WORCESTER, MA 01655-0002
(508) 334-3850
(508) 334-9108
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
235534
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110083413A
—
MA
01
—
11969099
CAQH
MA
Enumeration date
03/09/2009
Last updated
11/19/2024
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