Provider Demographics
NPI:1629554738
Name:BANKOWSKI, MATTHEW JOSEPH (MS, PHD, D(ABMM))
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:BANKOWSKI
Suffix:
Gender:M
Credentials:MS, PHD, D(ABMM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 HAMPTON HILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-6207
Mailing Address - Country:US
Mailing Address - Phone:612-801-2597
Mailing Address - Fax:
Practice Address - Street 1:7608 HAMPTON HILLS LOOP
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-6207
Practice Address - Country:US
Practice Address - Phone:612-801-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDI30550247ZC0005X, 207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician