Provider Demographics
NPI:1023008240
Name:BANSON, NORBERTINA L (MD)
Entity Type:Individual
Prefix:
First Name:NORBERTINA
Middle Name:L
Last Name:BANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 GLENROCK RD
Mailing Address - Street 2:STE 100A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3767
Mailing Address - Country:US
Mailing Address - Phone:757-252-3370
Mailing Address - Fax:757-252-3225
Practice Address - Street 1:835 GLENROCK RD
Practice Address - Street 2:STE 100A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3767
Practice Address - Country:US
Practice Address - Phone:757-252-3370
Practice Address - Fax:757-252-3225
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012340922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00006705OtherRAILROAD MEDICARE
VA7248237Medicaid
001245P33Medicare ID - Type Unspecified
VA7248237Medicaid