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General NPI Number Information
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NPI Number | 1548328875
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Entity Type | Individual
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Provider Name | RAYMOND ANTHONY BANNAN
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 2101 JACOB ST. SUITE 201 VALLEY PROF CENTER SOUTH
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City | WHEELING
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State | WV
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Zip | 26003-6390
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Country | US
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Telephone | 304-242-9245
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Fax | 304-242-6870
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Provider Business Mailing Address
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Address Line | 300 WHARTON CIR STE 120
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City | TRIADELPHIA
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State | WV
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Zip | 26059-1293
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Country | US
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Telephone | 304-242-9245
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Fax | 304-242-6870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 16474
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License Number State | WV
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