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Individual

ANGELA PAIGE BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255

Taxonomy

Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
200001098
NC
2085N0904X
Nuclear Radiology Physician
Primary
200001098
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10005299
VA
01
1339U
BCBS
NC
05
1841917000
WV
01
7606737
AETNA
NC
01
802876
PARTNERS
NC
05
891339U
NC
01
C6266
MEDCOST
NC
05
Q98000
SC
Enumeration date
12/01/2005
Last updated
01/08/2014
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