Individual
MATTHEW BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 W 7TH ST, FREDERICK, MD 21701-4506
(240) 566-3300
Mailing address
PO BOX 3252, INDIANAPOLIS, IN 46206-3252
(240) 566-3300
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D39418
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300020366
RAILROAD MEDICARE
MD
Enumeration date
06/26/2006
Last updated
09/01/2015
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