Provider Demographics
NPI:1952626210
Name:EMAD R AL BANNA,M.D.P.A.
Entity Type:Organization
Organization Name:EMAD R AL BANNA,M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:RASHAD
Authorized Official - Last Name:AL BANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-535-2044
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:1050 SOLOMONS ISLAND RD
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2102
Mailing Address - Country:US
Mailing Address - Phone:410-535-2044
Mailing Address - Fax:410-535-9324
Practice Address - Street 1:1050 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639
Practice Address - Country:US
Practice Address - Phone:410-535-2044
Practice Address - Fax:410-535-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD12705261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116161000Medicaid
B66735Medicare UPIN
MD116161000Medicaid