Provider Demographics
NPI:1114907219
Name:BENNETT, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2717
Mailing Address - Fax:610-270-2675
Practice Address - Street 1:1301 POWELL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3323
Practice Address - Country:US
Practice Address - Phone:610-270-2717
Practice Address - Fax:610-270-2675
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051325L207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01479660OtherAMERICHOICE(UHC)
PAMD051325LOtherHEALTH PARTNERS
PA0724619000OtherIBC - PC, KHPE, AMERIHEAL
PA5981601OtherAETNA PPO
PA8439971OtherCIGNA HMO/PPO
PA001479660Medicaid
PA2443406OtherAETNA HMO
PA050065882OtherRR MEDICARE
PA190060OtherHIGHMARK BLUE SHIELD
PA9061010OtherPHCS
PA1099349OtherKEYSTONE MERCY
PA0724619000OtherAMERIHEALTH/INTERCOUNTY
PA190060Medicare ID - Type UnspecifiedHMR MODIFIER
PA050065882OtherRR MEDICARE