Provider Demographics
NPI:1942468426
Name:EDWARDS-BENNETT, SOPHIA MAE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:MAE
Last Name:EDWARDS-BENNETT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3804
Mailing Address - Country:US
Mailing Address - Phone:304-399-6500
Mailing Address - Fax:304-399-6621
Practice Address - Street 1:1400 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4114
Practice Address - Country:US
Practice Address - Phone:304-399-6500
Practice Address - Fax:304-399-6621
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL344832085R0001X
FLME1080662085R0001X
SCMD344832085R0001X
NY24405-12085R0203X
WV344732085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921093Medicaid
SC80023852OtherSELECT HEALTH
SC692677OtherWELLCARE
SC344835Medicaid
SC4952170OtherCIGNA
SCP01070951OtherRAILROAD MEDICARE
WV1942468426Medicaid
SC9322600OtherAETNA