Provider Demographics
NPI:1093714057
Name:BANFER, RAYMOND E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:BANFER
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 1:109 RAYLOC DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1518
Mailing Address - Country:US
Mailing Address - Phone:301-678-5187
Mailing Address - Fax:301-678-5797
Practice Address - Street 1:621 KELLY RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2878
Practice Address - Country:US
Practice Address - Phone:301-722-3270
Practice Address - Fax:301-722-3276
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035061003Medicaid
21-1828OtherMEDICARE FQHC
9977OtherKAISER
14572700OtherFEDERAL WORKMANS COMP
2109844OtherAETNA HMO
418623.OtherUPMC
MD013087700Medicaid
0003OtherBCBS
53281812OtherBCBS
8133446OtherMAMSI
PA1007288800003Medicaid
E618-0032OtherCAREFIRST
1362198OtherAETNA PPO
MD217121100Medicaid
0003OtherBCBS
E53245Medicare UPIN
21-1828OtherMEDICARE FQHC