Individual
DR. TERESA JEAN BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 TRADEPARK DR, SUITE B, SOMERSET, KY 42503-3454
(606) 679-9292
(606) 679-9294
Mailing address
3504 WOODHAVEN DR, SOMERSET, KY 42503-9528
(606) 679-4919
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
22399
KY
207ND0101X
MOHS-Micrographic Surgery Physician
22399
KY
207ND0900X
Dermatopathology Physician
22399
KY
207NS0135X
Procedural Dermatology Physician
22399
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048629
ANTHEM
—
01
—
070007354
RAILROAD MEDICARE
—
05
—
64223993
—
KY
Enumeration date
01/18/2007
Last updated
03/07/2023
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