Provider Demographics
NPI:1588625172
Name:BANGHART, MARIA ELENA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA ELENA
Middle Name:
Last Name:BANGHART
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 1:222 ALEXANDER ST
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4039
Mailing Address - Country:US
Mailing Address - Phone:585-922-8210
Mailing Address - Fax:585-922-8260
Practice Address - Street 1:222 ALEXANDER ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4039
Practice Address - Country:US
Practice Address - Phone:585-922-8210
Practice Address - Fax:585-922-8260
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196550208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01685327Medicaid