Individual
DR. SOJA PARK BENNETT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 PARKMAN ST, PEDIATRIC ALLERGY YAW 6C, BOSTON, MA 02114-3117
(617) 726-2909
(617) 724-0581
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
73633
MA
2080P0205X
Pediatric Endocrinology Physician
Primary
73633
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3081125
—
MA
01
—
728160
TUFTS HEALTH PLAN
MA
01
—
J10670
BCBS MA
MA
Enumeration date
10/25/2005
Last updated
09/11/2025
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