Provider Demographics
NPI:1619970746
Name:BANNISTER, JAY BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY BRYAN
Middle Name:
Last Name:BANNISTER
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 1:250 PLEASANT ST
Mailing Address - Street 2:FHC CONCORD, YEAPLE BUILDING
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:FHC CONCORD, YEAPLE BUILDING
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA95518OtherHARVARD PILGRIM
NH222594672OtherPRIVATE HEALTH CARE
NH538777OtherCIGNA
NH222594672OtherMARTINS POINT
NH9034053OtherAETNA
01YP03530NH02OtherANTHEM
NH222594672OtherGREATWEST HEALTH CARE
NH30201994Medicaid
NH222594672OtherUNITED HEALTH CARE
NH222594672OtherTRICARE
NH371511OtherMVP
NHH50657Medicare ID - Type Unspecified
01YP03530NH02OtherANTHEM