Kelly, Lawrence Bennett

Kelly, Lawrence Bennett is an sole proprietor health care provider with primary practice located at 4825 Maccorkle Ave Sw Ste C , South Charleston WV 25309-1365. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Kelly, Lawrence Bennett can be contacted via phone (304) 343-1022.

Contact Information

Primary practice address
4825 Maccorkle Ave Sw Ste C South Charleston WV 25309-1365
Phone: (304) 343-1022
Fax: (304) 343-1025
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 12306 West Virginia

Profile Details

NPI number 1629031901
LBN Legal business name Kelly, Lawrence Bennett
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 8th, 2006
Last updated Feb 2nd, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629031901 NPPES
West Virginia Other 001720795 BLUE CROSS BLUE SHIELD
West Virginia MEDICAID 0114543001 BLUE CROSS BLUE SHIELD
West Virginia Other 260047649 BLUE CROSS BLUE SHIELD

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