Individual
DR. SEAN ROBERT BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
433 EDNAM DRIVE, CHARLOTTESVILLE, VA 22903
(603) 236-2258
Mailing address
433 EDNAM DRIVE, CHARLOTTESVILLE, VA 22903
(603) 236-2258
Taxonomy
Speciality
Code
Description
License number
State
261QR1100X
Research Clinic/Center
Primary
0101240200
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101242200
MEDICAL LICENSE
VA
Enumeration date
08/01/2019
Last updated
08/01/2019
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