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NPI Code Detail

MEDICARE: PAMELA K BANISTER M.D.

MEDICARE: PAMELA K BANISTER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianK7991TX
2207Q00000XFamily Medicine Physician2022-02296NC
3207Q00000XFamily Medicine Physician12878MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21D7229OTHERTXMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043212616
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA K BANISTER M.D.
Provider Business Mailing Address
First Line : 300 E WENDOVER AVE
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1229
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1123 N CHURCH ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1007
Country : US
Telephone Number : 336-832-4400
Fax Number : 336-832-4440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 01/12/2026

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