1396717898 NPI number — DENIS M BANE MD

Table of content: DENIS M BANE MD (NPI 1396717898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396717898 NPI number — DENIS M BANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANE
Provider First Name:
DENIS
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1396717898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 S CLAUDE A LORD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17901-3637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-622-4209
Provider Business Mailing Address Fax Number:
570-622-1386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 S CLAUDE A LORD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-3637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-4209
Provider Business Practice Location Address Fax Number:
570-622-1386
Provider Enumeration Date:
02/07/2006

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: 207R00000X , with the licence number:  MD011754E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000148034 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0473231 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 110201291 . This is a "RAILROAD MEDICARE PBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006942510004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0064387000 . This is a "BLUE CROSS PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01164201 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 020301000 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19928 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 116993900 . This is a "FEDERAL EMPLOYEES COMP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01164201 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0998130 . This is a "KEYSTONE SPECIALIST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com