Provider Demographics
NPI:1043425036
Name:BANKER, RAJESH S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:S
Last Name:BANKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-478-7373
Mailing Address - Fax:949-650-2898
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-478-7373
Practice Address - Fax:949-650-2898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90635207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC027XOtherMEDICARE INDIVIDUAL PTAN ASSIGNED TO PREMIER CARDIOLOGY