Healthcare Provider Details

I. General information

NPI: 1326142423
Provider Name (Legal Business Name): ADRIAN S BANNING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE DHMC DEPERTMENT OF GENERAL INTERNAL MEDICINE LYME ROAD
LEBANON NH
03756-0001
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE DHMC DEPERTMENT OF GENERAL INTERNAL MEDICINE LYME ROAD
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-1070
  • Fax: 603-650-1076
Mailing address:
  • Phone: 603-650-1070
  • Fax: 603-650-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0667
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055-0030785
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: