Healthcare Provider Details

I. General information

NPI: 1386807766
Provider Name (Legal Business Name): CAROLINE A BANKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST
BOSTON MA
02114-3096
US

IV. Provider business mailing address

243 CHARLES ST
BOSTON MA
02114-3096
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-3641
  • Fax: 617-573-3727
Mailing address:
  • Phone: 617-573-3641
  • Fax: 617-573-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number265454
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number265454
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: