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NPI Code Detail

MEDICARE: RICHARD NEIL BANEY JR. M.D.

MEDICARE: RICHARD NEIL BANEY JR. 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
1207R00000XInternal Medicine Physician89132GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110117266OTHERFLRR MEDICARE

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 : 1821081589
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD NEIL BANEY JR. M.D.
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 770-629-3217
Fax Number :
Provider Business Practice Location Address
First Line : 2124 CANDLER RD
Second Line :
City : DECATUR
State : GA
Zip : 30032-5572
Country : US
Telephone Number : 404-836-0272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2005
Last Update Date : 05/02/2022

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