Provider Demographics
NPI:1881686897
Name:BANKO, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:BANKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4 TRAFALGAR DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1325
Mailing Address - Country:US
Mailing Address - Phone:518-561-8734
Mailing Address - Fax:518-561-7843
Practice Address - Street 1:15 DEGRANDPRE WAY
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6449
Practice Address - Country:US
Practice Address - Phone:518-561-3900
Practice Address - Fax:518-561-7843
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY153178208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00967235Medicaid
NYD01974Medicare UPIN
NYUR33564EMedicare ID - Type Unspecified