Provider Demographics
NPI:1366412736
Name:BENNETT, LORI KAY (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:KAY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1340 HAL GREER BLVD
Mailing Address - Street 2:ATTN: TAMMIE SILVA
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-526-2053
Mailing Address - Fax:
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-526-2200
Practice Address - Fax:304-526-2139
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV13107207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0050258000Medicaid
OH0525962Medicaid
KY64699317Medicaid
WVP00272976OtherMEDICARE-RR PROVIDER NUMBER
WV0734023OtherMEDICARE PIN FOR OCCU MED
WV0050258000Medicaid