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General NPI Number Information
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NPI Number | 1609419068
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Entity Type | Individual
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Provider Name | BROOKE BANOS
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 8116 GOOD LUCK RD STE 305
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City | LANHAM
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State | MD
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Zip | 20706-3508
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Country | US
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Telephone | 301-552-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 6913 RAVEN LN
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City | COLUMBIA
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State | MD
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Zip | 21044-4257
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Country | US
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Telephone | 443-878-6071
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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