Individual
THOMAS LAVELL BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 JOHN PAUL JONES CIRCLE, NAVAL MEDICAL CENTER PORTSMOUTH, PORTSMOUTH, VA 23708
(757) 953-2518
Mailing address
222 E 4TH ST, MOUNT VERNON, NY 10553-1414
(978) 968-9511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101254422
VA
Other
Enumeration date
02/17/2012
Last updated
12/07/2021
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