Healthcare Provider Details

I. General information

NPI: 1881005007
Provider Name (Legal Business Name): ALEXANDER BANASHKEVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E. ADAMS STREET UPSTATE MEDICAL UNIVERSITY DEPT. OF RADIATION ONCOLOGY
SYRACUSE NY
13210
US

IV. Provider business mailing address

750 E. ADAMS STREET UPSTATE MEDICAL UNIVERSITY DEPT. OF RADIATION ONCOLOGY
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5276
  • Fax:
Mailing address:
  • Phone: 315-464-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number274913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: