Provider Demographics
NPI:1043383730
Name:AL-BANNA, EMAD RASHAD (MD)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:RASHAD
Last Name:AL-BANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EMAD
Other - Middle Name:R
Other - Last Name:ALBANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDPA
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2102
Mailing Address - Country:US
Mailing Address - Phone:410-535-2044
Mailing Address - Fax:410-535-9324
Practice Address - Street 1:1050 SOLOLMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERIC
Practice Address - State:MD
Practice Address - Zip Code:20678-2067
Practice Address - Country:US
Practice Address - Phone:410-535-2044
Practice Address - Fax:410-535-9324
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012705208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116161000Medicaid
B66735Medicare UPIN
MD116161000Medicaid