Provider Demographics
NPI:1760468110
Name:BANISH, WILLIAM PAUL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:BANISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:10512 PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-542-3631
Practice Address - Fax:704-542-3646
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19490208600000X
NC2015-00687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC76051OtherMEDCOST
SC770001362OtherBANKERS LIFE AND CASUALTY
NC1760468110Medicaid
SCT37948Medicaid
SC9645030OtherGHI
SC620108OtherSELECT HEALTH
SC9377345OtherCIGNA
SCT37948Medicaid
SC76051OtherMEDCOST