Provider Demographics
NPI:1225073547
Name:BANZON, VICTOR
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BANZON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SAVANNAH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1499
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:400 SAVANNAH RD
Practice Address - Street 2:SUITE B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1499
Practice Address - Country:US
Practice Address - Phone:302-645-3555
Practice Address - Fax:302-644-3560
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015670207R00000X, 208M00000X
DEC1-0009622207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205558Medicaid
ME314130099Medicaid
MEMM921101Medicare PIN
MEP00410400Medicare PIN
ME314130099Medicaid
MEMM9211Medicare PIN