MEDICARE: DR. AMY LYNNE BANULIS MD

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	207V00000X	Obstetrics & Gynecology Physician	D63032	MD
2	207V00000X	Obstetrics & Gynecology Physician	MD035425	DC

General Provider Information

NPI Number	:	1730240920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LYNNE BANULIS MD

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-6424
Fax Number	:	301-816-6308

Provider Business Practice Location Address
First Line	:	2100 PENNSYLVANIA AVE NW
Second Line	:	WEST END MEDICAL CENTER
City	:	WASHINGTON
State	:	DC
Zip	:	20037-3202
Country	:	US
Telephone Number	:	202-872-7000
Fax Number	:	202-872-7212

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	05/31/2021

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