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General NPI Number Information
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NPI Number | 1700872413
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Entity Type | Organization
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Legal Business Name | ROBERT BANCO, MD PC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 125 PARKER HILL AVE CONVERSE 4
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City | ROXBURY CROSSING
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State | MA
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Zip | 02120-2847
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Country | US
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Telephone | 617-754-5630
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Fax | 617-754-5593
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Provider Business Mailing Address
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Address Line | 125 PARKER HILL AVE CONVERSE 4
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City | ROXBURY CROSSING
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State | MA
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Zip | 02120-2847
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Country | US
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Telephone | 617-754-5630
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Fax | 617-754-5593
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT J BANCO
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Credential | M.D.
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Telephone | 617-754-5630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 59668
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License Number State | MA
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