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General NPI Number Information
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NPI Number | 1821079773
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Entity Type | Individual
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Provider Name | DOROTHY H BANISH M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 67250 INDUSTRY LN SUITE B
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City | COVINGTON
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State | LA
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Zip | 70433-8716
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Country | US
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Telephone | 985-893-4711
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Fax | 985-893-9094
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Provider Business Mailing Address
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Address Line | PO BOX 8865
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City | MANDEVILLE
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State | LA
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Zip | 70470-8865
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Country | US
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Telephone | 985-893-4711
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Fax | 985-893-9094
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 015918
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License Number State | LA
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