Provider Demographics
NPI:1154758548
Name:BENNINGTON, JAMES LYNNE (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LYNNE
Last Name:BENNINGTON
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:P.O. BOX 1275
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:CA
Mailing Address - Zip Code:94920
Mailing Address - Country:US
Mailing Address - Phone:415-435-7706
Mailing Address - Fax:415-435-8469
Practice Address - Street 1:55 BEACH ROAD
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:CA
Practice Address - Zip Code:94920
Practice Address - Country:US
Practice Address - Phone:415-435-7706
Practice Address - Fax:415-435-8469
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE24056207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology