Provider Demographics
NPI:1326142423
Name:BANNING, ADRIAN S (PA)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:S
Last Name:BANNING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:DHMC DEPERTMENT OF GENERAL INTERNAL MEDICINE LYME ROAD
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-1070
Mailing Address - Fax:603-650-1076
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:DHMC DEPERTMENT OF GENERAL INTERNAL MEDICINE LYME ROAD
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-1070
Practice Address - Fax:603-650-1076
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0667363A00000X
VT055-0030785363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT055-0030785OtherLICENSE
Q73139Medicare UPIN