Individual
DR. MARK R BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 STADIUM DR, MORGANTOWN, WV 26506-7911
(304) 598-4000
Mailing address
PO BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
13482
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011245770006
—
PA
05
—
0057577000
—
WV
05
—
0698428
—
OH
05
—
409551100
—
MD
05
—
64113103
—
KY
Enumeration date
03/08/2006
Last updated
11/05/2008
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