Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 0101243894 | VA |
N | 207RG0100X | Gastroenterologist | 200401498 | NC |
NPI | 1033265848 |
---|---|
Provider Name | Bennett Ira Fein |
First Address | Martinsville, VA 24112-1929 |
Second Address | Martinsville, VA 24112-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 26/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033265848 | (05) | VA |
5900806 | (05) | NC |
E56359 | (02) |