Basic Information
| Provider Information | |||||||||
| NPI: | 1053375816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5295 PRESERVE PKWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352444701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056826077 | ||||||||
| FaxNumber: | 2056827646 | ||||||||
| Practice Location | |||||||||
| Address1: | 5295 PRESERVE PKWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352444701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056826077 | ||||||||
| FaxNumber: | 2056827646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 06/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 19290 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009935312 | 05 | AL | MEDICAID |