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NPI Code Detail

MEDICARE: TRACEY COLLEEN BANG M.D.

MEDICARE: TRACEY COLLEEN BANG 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
1208000000XPediatrics Physician35080620OH

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 : 1871591107
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY COLLEEN BANG M.D.
Provider Business Mailing Address
First Line : 555 S 18TH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43205-2654
Country : US
Telephone Number : 614-722-4554
Fax Number : 614-722-4565
Provider Business Practice Location Address
First Line : 555 S 18TH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43205-2654
Country : US
Telephone Number : 614-722-4554
Fax Number : 614-722-4565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 07/08/2007

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Directions to “ TRACEY COLLEEN BANG M.D.” Practice Location

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