Provider Demographics
NPI:1750686952
Name:BANKS HEPATOLOGY INSTITUTE, PC
Entity Type:Organization
Organization Name:BANKS HEPATOLOGY INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HENRIQUE
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-699-2292
Mailing Address - Street 1:7404 EXECUTIVE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6237
Mailing Address - Country:US
Mailing Address - Phone:301-699-2292
Mailing Address - Fax:301-699-2293
Practice Address - Street 1:7404 EXECUTIVE PL STE 101
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6237
Practice Address - Country:US
Practice Address - Phone:301-699-2292
Practice Address - Fax:301-699-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040381261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty