Michelle Bornstein Bennett, MD
Individual provider Active NPI Pediatric Adolescent Medicine Physician · Cumberland, RI
NPI 1508070376 · NPPES record last updated Feb 17, 2022
Key facts
- NPI
- 1508070376
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Adolescent Medicine Physician 2080A0000X
- License
- MD12301 (RI)
- Practice address
- 175 Nate Whipple Hwy Ste 102
Cumberland, RI 02864-1422 - Phone
- (401) 334-5437
- Fax
- (401) 334-3571
- NPI assigned
- May 10, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD12301 | RI | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Rhode Island Pediatrics | Adolescent Medicine | Past | Accepting new patients |
| Nri Pediatrics PC | Adolescent Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | MD12301 | RI | Yes |
Addresses
Primary practice location
175 Nate Whipple Hwy Ste 102
Cumberland, RI 02864-1422
Mailing address
175 Nate Whipple Hwy Ste 102
Cumberland, RI 02864-1422
Phone (401) 334-5437
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD12301 | Other | RI | STATE LICENSE NUMBER |
Other providers in Cumberland, RI
- Blackstone Psychology Group
- Blackstone Valley Family Therapy, LTD.
- Blackstone Valley Hearing Centers, Inc.
- Blackstone Valley Pediatrics
- Amanda Blanchard
- Karen A Bouchard
- Matthew Boucher
- Nompelelo Khumalo Boucher
- Robert Bouffard
- Guy M Boulay
All providers in Cumberland, RI · Pediatric Adolescent Medicine Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.