Provider Demographics
NPI:1285709436
Name:RICARDO M. BENNETT DPM
Entity type:Organization
Organization Name:RICARDO M. BENNETT DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-538-5111
Mailing Address - Street 1:5275 LEE HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1619
Mailing Address - Country:US
Mailing Address - Phone:703-538-5111
Mailing Address - Fax:703-538-4193
Practice Address - Street 1:5275 LEE HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:703-538-5111
Practice Address - Fax:703-538-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA271860OtherANTHEM-VA
VA271860OtherANTHEM-VA
VA=========OtherTRICARE
VA=========OtherHORIZON
VA271860OtherANTHEM-VA
VA909539Medicare ID - Type Unspecified
VAU66217Medicare UPIN