Provider Demographics
NPI:1730316217
Name:BANO, FASAHAT (MD)
Entity Type:Individual
Prefix:
First Name:FASAHAT
Middle Name:
Last Name:BANO
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 1:14690 ALI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8829
Mailing Address - Country:US
Mailing Address - Phone:440-891-8239
Mailing Address - Fax:
Practice Address - Street 1:2301 BELMONT AVENE
Practice Address - Street 2:PRIMARY CARE CLINIC IN YOUNGSTOWN, OHIO (VETERANS ADMIN
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:330-740-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.011241207R00000X
FLME105212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine