Provider Demographics
NPI:1053375816
Name:BENNETT, MARIA E (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 PRESERVE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4701
Mailing Address - Country:US
Mailing Address - Phone:205-682-6077
Mailing Address - Fax:205-682-7646
Practice Address - Street 1:5295 PRESERVE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4701
Practice Address - Country:US
Practice Address - Phone:205-682-6077
Practice Address - Fax:205-682-7646
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935312Medicaid
AL009935312Medicaid
ALG22253Medicare UPIN