Healthcare Provider Details

I. General information

NPI: 1760468110
Provider Name (Legal Business Name): WILLIAM PAUL BANISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MATTHEWS TOWNSHIP PKWY STE 250
MATTHEWS NC
28105-5331
US

IV. Provider business mailing address

PO BOX 604350
CHARLOTTE NC
28260-4350
US

V. Phone/Fax

Practice location:
  • Phone: 704-841-1444
  • Fax: 704-849-2520
Mailing address:
  • Phone: 704-364-8100
  • Fax: 704-365-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19490
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2015-00687
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: