Provider Demographics
NPI:1285777656
Name:BINGHAM, DENNIS AL (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:AL
Last Name:BINGHAM
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 1:550 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-9172
Mailing Address - Country:US
Mailing Address - Phone:937-687-1911
Mailing Address - Fax:937-687-1888
Practice Address - Street 1:550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9172
Practice Address - Country:US
Practice Address - Phone:937-687-1911
Practice Address - Fax:937-687-1888
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000281750OtherANTHEM BLUE CROSS BLUE SH
OH0317142Medicaid
OH0317142Medicaid
OH000000281750OtherANTHEM BLUE CROSS BLUE SH