Healthcare Provider Details

I. General information

NPI: 1568102051
Provider Name (Legal Business Name): BRIAN BANAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 MENOHER DR
JB ANDREWS MD
20762-6503
US

IV. Provider business mailing address

1191 MENOHER DR
JB ANDREWS MD
20762-6503
US

V. Phone/Fax

Practice location:
  • Phone: 202-400-8556
  • Fax: 202-400-8854
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0107095
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: