Healthcare Provider Details

I. General information

NPI: 1114913837
Provider Name (Legal Business Name): JAMES RUSSELL BANKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PENINSULA FARM RD
ARNOLD MD
21012-1011
US

IV. Provider business mailing address

277 PENINSULA FARM RD
ARNOLD MD
21012-1011
US

V. Phone/Fax

Practice location:
  • Phone: 410-647-2600
  • Fax: 410-647-4953
Mailing address:
  • Phone: 410-647-2600
  • Fax: 410-647-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0027691
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: