Individual
CHARLES WILLIAMS BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11845 HG TRUEMAN RD, LUSBY, MD 20657-2855
(410) 326-6344
(410) 326-0079
Mailing address
11845 HG TRUEMAN RD, LUSBY, MD 20657-2855
(410) 326-6344
(410) 326-0079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D25156
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0516987
AETNA
—
01
—
291571
MAMSI
—
01
—
KS56
CAREFIRST MARYLAND
MD
01
—
T5080001
CAREFIRST FEDERAL PLAN
MD
Enumeration date
01/23/2006
Last updated
07/08/2007
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