Provider Demographics
NPI:1821079773
Name:BANISH, DOROTHY H (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:H
Last Name:BANISH
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:PO BOX 8865
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-8865
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015918207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1349071Medicaid
LA5M761Medicare ID - Type Unspecified
LA1349071Medicaid