Provider Demographics
NPI:1245223197
Name:BANKER, MILLARD F IV (MD)
Entity Type:Individual
Prefix:
First Name:MILLARD
Middle Name:F
Last Name:BANKER
Suffix:IV
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:PO BOX 602463
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2463
Mailing Address - Country:US
Mailing Address - Phone:252-447-7088
Mailing Address - Fax:252-447-2752
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8000
Practice Address - Fax:252-635-6951
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36647207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913205Medicaid
NC13205OtherBLUE CROSS
NC2189156Medicare ID - Type Unspecified
NC13205OtherBLUE CROSS
NC110090027Medicare PIN