Organization
INDEPENDENCE HEALTH PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD L BENNETT MD (PRESIDENT)
(919) 622-8272
Entity
Organization
Contact information
Practice address
515 BARBOUR RD, SMITHFIELD, NC 27577-7698
(919) 934-6017
(919) 934-2057
Mailing address
1209 FALLS BRIDGE DR, RALEIGH, NC 27614-8935
(919) 622-8272
(919) 847-3526
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
36492
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO0034
MEDICARE RAILROAD
NC
Enumeration date
05/28/2008
Last updated
10/31/2013
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