Provider Demographics
NPI:1558659367
Name:BANU, DRAGOS (MD)
Entity Type:Individual
Prefix:DR
First Name:DRAGOS
Middle Name:
Last Name:BANU
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 1:183 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1238
Mailing Address - Country:US
Mailing Address - Phone:518-481-2287
Mailing Address - Fax:
Practice Address - Street 1:183 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1238
Practice Address - Country:US
Practice Address - Phone:518-481-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0015443207R00000X
NY275563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine