Basic Information
| Provider Information | |||||||||
| NPI: | 1962440628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENTT | ||||||||
| FirstName: | LAVERN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7611 MAPLE AVE | ||||||||
| Address2: | #407 | ||||||||
| City: | TAKOMA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209125559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023783307 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE NW HUH B105 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200602306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656100 | ||||||||
| FaxNumber: | 2028656713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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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 | 207L00000X | 240118 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.