Healthcare Provider Details

I. General information

NPI: 1750686952
Provider Name (Legal Business Name): BANKS HEPATOLOGY INSTITUTE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 EXECUTIVE PL STE 101
LANHAM MD
20706-6237
US

IV. Provider business mailing address

7404 EXECUTIVE PL STE 101
LANHAM MD
20706-6237
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-2292
  • Fax: 301-699-2293
Mailing address:
  • Phone: 301-699-2292
  • Fax: 301-699-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD0040381
License Number StateMD

VIII. Authorized Official

Name: MR. MICHAEL HENRIQUE BLAIR
Title or Position: GENERAL MANAGER
Credential:
Phone: 301-699-2292