MEDICARE: ROBERT J BANCO M.D.

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	59668	MA

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	:	1265434948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J BANCO M.D.

Provider Business Mailing Address
First Line	:	25 WASHINGTON ST UNIT 1B
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1752
Country	:	US
Telephone Number	:	617-219-6300
Fax Number	:	617-219-6355

Provider Business Practice Location Address
First Line	:	25 WASHINGTON ST UNIT 1B
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1752
Country	:	US
Telephone Number	:	617-219-6300
Fax Number	:	617-219-6355

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/25/2022

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