Individual
AMANDA K BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2585 3RD AVENUE, HUNTINGTON, WV 25703
(304) 781-5138
Mailing address
PO BOX 1680, HUNTINGTON, WV 25707-1680
(304) 697-1396
(304) 697-2086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101238081
VA
207Q00000X
Family Medicine Physician
Primary
21674
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00318137
RAILROAD MEDICARE
WV
05
—
2655827
—
OH
05
—
3810005272
—
WV
Enumeration date
01/25/2006
Last updated
07/29/2008
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