Provider Demographics
NPI:1952500225
Name:BANASKI, REBECCA A (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BANASKI
Suffix:
Gender:M
Credentials:DO
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 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-3437
Mailing Address - Country:US
Mailing Address - Phone:617-726-3884
Mailing Address - Fax:603-743-3171
Practice Address - Street 1:770 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3437
Practice Address - Country:US
Practice Address - Phone:603-742-0101
Practice Address - Fax:603-743-3171
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH13573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076391Medicaid