Provider Demographics
NPI:1518022441
Name:BANN, DAVID VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VINCENT
Last Name:BANN
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:
Practice Address - Street 1:9 HEALTHCARE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9449
Practice Address - Country:US
Practice Address - Phone:207-282-4270
Practice Address - Fax:207-282-7350
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 92972084P0800X
ME0174262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0105587Y0NH01OtherANTHEM
NH889985OtherMVP HEALTHCARE
NHP00120288OtherTRAVELERS
NH889985OtherMVP HEALTHCARE
NHP00120288OtherTRAVELERS
NH52M521Medicare UPIN
ME000207001Medicare PIN