Basic Information
| Provider Information | |||||||||
| NPI: | 1134136435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNING | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 03/17/2016 | ||||||||
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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 | 248669 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042297845 | 01 | TRICARE | OTHER | 110089181A | 01 | MA | MEDICAID | OTHER | 1134136435 | 01 | FALLON | OTHER | 042297845 | 01 | HVMA/FIRST HEALTH/COVENTRY | OTHER | 042297845 | 01 | PHCS/MULTI-PLAN | OTHER | AA217699 | 01 | HARVARD PILGRIM | OTHER | 04-2297845 | 01 | UNITED HEALTH CARE | OTHER | 042297845 | 01 | UNITED HEALTH CARE | OTHER | 769190 | 01 | TUFTS AND TUFTS MEDICARE PREFERRED | OTHER | 0816728 | 01 | CIGNA | OTHER | J49047 | 01 | MA | BCBSMA | OTHER | 042297845 | 01 | GIV/UNICARE | OTHER | 1134136435 | 01 | NHP | OTHER |