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NPI Code Detail

MEDICARE: LAURIE A BANKSTON M.D.

MEDICARE: LAURIE A BANKSTON 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
1207Q00000XFamily Medicine Physician35079398OH

Other Identifiers

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

General Provider Information

NPI Number : 1295790343
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE A BANKSTON M.D.
Provider Business Mailing Address
First Line : 50 N PROGRESS DR
Second Line :
City : XENIA
State : OH
Zip : 45385-2666
Country : US
Telephone Number : 937-562-2280
Fax Number : 937-562-2282
Provider Business Practice Location Address
First Line : 50 N PROGRESS DR
Second Line :
City : XENIA
State : OH
Zip : 45385-2666
Country : US
Telephone Number : 937-562-2280
Fax Number : 937-562-2282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 11/19/2020

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Directions to “ LAURIE A BANKSTON M.D.” Practice Location

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