Individual
LISA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3900 WESTERRE PKWY STE 300, RICHMOND, VA 23233-1339
(954) 399-4673
Mailing address
3601 SW 160TH AVE STE 250, MIRAMAR, FL 33027-6314
(954) 399-4673
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101280908
VA
207P00000X
Emergency Medicine Physician
35078924B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2224257
—
OH
01
—
942460636373
CARESOURCE
OH
01
—
P00250500
MEDICARE RR-GA
OH
Enumeration date
06/08/2006
Last updated
11/13/2024
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