Provider Demographics
NPI:1659348563
Name:BANKS, VIRGINIA DEEANNE (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DEEANNE
Last Name:BANKS
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 1:875 N HERMITAGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3278
Mailing Address - Country:US
Mailing Address - Phone:724-347-4654
Mailing Address - Fax:724-347-4784
Practice Address - Street 1:875 N HERMITAGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3278
Practice Address - Country:US
Practice Address - Phone:724-347-4654
Practice Address - Fax:724-347-4784
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044146L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011763400008Medicaid
PA0011763400007Medicaid
OH0400113Medicaid
PA868031HB1Medicare PIN
OH0400113Medicaid
P00071863Medicare PIN