Provider Demographics
NPI:1942392899
Name:BANNEN, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:BANNEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:# 327 MILLER KAPLAN AND RAJAGOPAL PC
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-774-6136
Mailing Address - Fax:301-570-0136
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:# 327 MILLER KAPLAN AND RAJAGOPAL PC
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-774-6136
Practice Address - Fax:301-570-0136
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-12-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0060335207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD131901900Medicaid
MD131901900Medicaid
H96766Medicare UPIN