Provider Demographics
NPI:1073908752
Name:BANU, FULVIA CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:FULVIA
Middle Name:CARMEN
Last Name:BANU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FULVIA
Other - Middle Name:CARMEN
Other - Last Name:STEFANESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3241 EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3931
Mailing Address - Country:US
Mailing Address - Phone:954-985-6500
Mailing Address - Fax:954-967-8419
Practice Address - Street 1:1724 E HALLANDALE BEACH BLVD # 2A
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4611
Practice Address - Country:US
Practice Address - Phone:954-456-9696
Practice Address - Fax:954-456-9626
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty