Provider Demographics
NPI:1790077162
Name:DOROTHY H BANISH MD APMC
Entity Type:Organization
Organization Name:DOROTHY H BANISH MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BANISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-893-4711
Mailing Address - Street 1:67250 INDUSTRY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8716
Mailing Address - Country:US
Mailing Address - Phone:985-893-4711
Mailing Address - Fax:985-893-9094
Practice Address - Street 1:67250 INDUSTRY LN
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8716
Practice Address - Country:US
Practice Address - Phone:985-893-4711
Practice Address - Fax:985-893-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015918207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty