MEDICARE: DR. TODD RICHARD BANNING D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	OS-008961-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063425437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD RICHARD BANNING D.O.

Provider Business Mailing Address
First Line	:	1241 BLAKESLEE BOULEVARD DR E
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-2401
Country	:	US
Telephone Number	:	570-386-6900
Fax Number	:	570-386-6901

Provider Business Practice Location Address
First Line	:	1241 BLAKESLEE BOULEVARD DR E
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-2401
Country	:	US
Telephone Number	:	570-386-6900
Fax Number	:	570-386-6901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/12/2013

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