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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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