Individual
MARIKO BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1722
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1722
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MT215615
PA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
MT215615
PA
Other
Enumeration date
06/12/2018
Last updated
06/26/2020
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