Basic Information
| Provider Information | |||||||||
| NPI: | 1528041365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502100 | ||||||||
| FaxNumber: | 5083502314 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COMPASS WAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502100 | ||||||||
| FaxNumber: | 5083502314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 234083 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | S400429510 | 01 | MA | MEDICARE | OTHER |