Provider Demographics
NPI:1215958053
Name:BENNETT, DEAN R (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:R
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 71230
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-6230
Mailing Address - Country:US
Mailing Address - Phone:703-383-6424
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:703-471-5300
Practice Address - Fax:703-471-4391
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036600207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200019375OtherMEDICARE RAILROAD
VA6402062Medicaid
158180C95Medicare ID - Type Unspecified
VA6402062Medicaid
200019375OtherMEDICARE RAILROAD