Provider Demographics
NPI:1801867593
Name:BANKS, BENITA F (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITA
Middle Name:F
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 1:22 S GREENE ST, DEPT OF RADIOLOGY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-3477
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST, DEPT OF RADIOLOGY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00537502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026766800Medicaid
MD180003500Medicaid
MDKA80OtherB/C B/S
MDJ062OtherB/C B/S
DEDD4343Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD001344A00Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 99
MDKA80OtherB/C B/S
MD434L792VMedicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
DC2849OtherB/C B/S