1245490119 NPI number — NATALIE BANET MD

Table of content: NATALIE BANET MD (NPI 1245490119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245490119 NPI number — NATALIE BANET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANET
Provider First Name:
NATALIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245490119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 BLACKSTONE BLVD
Provider Second Line Business Mailing Address:
JOHNSON BLDG.
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-273-0641
Provider Business Mailing Address Fax Number:
401-273-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 NORTH BROADWAY
Provider Second Line Business Practice Location Address:
WEINBERG 2268
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21231-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-649-3267
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  D73958 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 056082100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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