Provider Demographics
NPI:1205858636
Name:BENNETT, CARMEN ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ANGELA
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:PO BOX 12725
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-6725
Mailing Address - Country:US
Mailing Address - Phone:205-325-7001
Mailing Address - Fax:205-325-1976
Practice Address - Street 1:3200 16TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4202
Practice Address - Country:US
Practice Address - Phone:205-325-7001
Practice Address - Fax:205-325-1976
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAPPLYING FOROtherBLUE CROSS
ALAPPLYING FOROtherBLUE CROSS
ALAPPLYING FORMedicare ID - Type Unspecified