Provider Demographics
NPI: | 1851686331 |
---|---|
Name: | TRABAND, ANASTASIA (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANASTASIA |
Middle Name: | |
Last Name: | TRABAND |
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: | 1 GRANITE POINT DR STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | WYOMISSING |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19610-1992 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-378-1344 |
Mailing Address - Fax: | 610-378-5169 |
Practice Address - Street 1: | 1 GRANITE POINT DR STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | WYOMISSING |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19610-1992 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-378-1344 |
Practice Address - Fax: | 610-378-9508 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-06-13 |
Last Update Date: | 2023-06-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD454223 | 207W00000X, 207WX0107X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207WX0107X | Allopathic & Osteopathic Physicians | Ophthalmology | Retina Specialist |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 1031125400005 | Medicaid | |
PA | 1031125400006 | Medicaid | |
PA | 1031125400003 | Medicaid |