Provider Demographics
NPI:1467457655
Name:KUPIEC-BANASIKOWSKA, AGNIESZKA (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:KUPIEC-BANASIKOWSKA
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 1:3301 NEW MEXICO AVE NW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3622
Mailing Address - Country:US
Mailing Address - Phone:202-363-9600
Mailing Address - Fax:202-363-9601
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:SUITE 210
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:202-363-9600
Practice Address - Fax:202-363-9601
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC33468207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66134Medicare UPIN
DC009855G65Medicare PIN