Provider Demographics
NPI:1083836399
Name:BANKS, ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:BANKS
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 1:1720 NICHOLASVILLE RD STE 602
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1488
Mailing Address - Country:US
Mailing Address - Phone:859-277-4005
Mailing Address - Fax:859-278-2507
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 602
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1488
Practice Address - Country:US
Practice Address - Phone:859-277-4005
Practice Address - Fax:859-278-2507
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34293207RI0200X
KY41845207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051541775OtherBLUE CROSS
AL009911114Medicaid
AL051541776OtherBLUE CROSS
AL009910453Medicaid
AL009911114Medicaid