MEDICARE: DR. JAY BRYAN BANNISTER MD

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
1	207Q00000X	Family Medicine Physician	11361	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA95518	OTHER	NH	HARVARD PILGRIM
2	222594672	OTHER	NH	PRIVATE HEALTH CARE
3	538777	OTHER	NH	CIGNA
4	222594672	OTHER	NH	MARTINS POINT
5	9034053	OTHER	NH	AETNA
6	01YP03530NH02	OTHER		ANTHEM
7	222594672	OTHER	NH	GREATWEST HEALTH CARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	222594672	OTHER	NH	UNITED HEALTH CARE
10	222594672	OTHER	NH	TRICARE
11	371511	OTHER	NH	MVP

General Provider Information

NPI Number	:	1619970746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY BRYAN BANNISTER MD

Provider Business Mailing Address
First Line	:	250 PLEASANT ST
Second Line	:	FHC CONCORD, YEAPLE BUILDING
City	:	CONCORD
State	:	NH
Zip	:	03301-7539
Country	:	US
Telephone Number	:	603-228-7200
Fax Number	:	603-228-7307

Provider Business Practice Location Address
First Line	:	250 PLEASANT ST
Second Line	:	FHC CONCORD, YEAPLE BUILDING
City	:	CONCORD
State	:	NH
Zip	:	03301-7539
Country	:	US
Telephone Number	:	603-228-7200
Fax Number	:	603-228-7307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/05/2011

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