Provider Demographics
NPI:1043647589
Name:AL-BANNA, REYADH DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:REYADH
Middle Name:DAVID
Last Name:AL-BANNA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 HOSPITAL DR
Mailing Address - Street 2:SUITE 802
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5803
Mailing Address - Country:US
Mailing Address - Phone:410-553-8290
Mailing Address - Fax:410-553-8288
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:SUITE 802
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-553-8290
Practice Address - Fax:410-553-8288
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant