Provider Demographics
NPI:1184898082
Name:DHIRENDRA S BANA, MD, PC
Entity type:Organization
Organization Name:DHIRENDRA S BANA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHIRENDRA
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-524-3700
Mailing Address - Street 1:1153 CENTRE ST STE 5935
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-524-3700
Mailing Address - Fax:617-524-5839
Practice Address - Street 1:1153 CENTRE ST STE 5935
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-524-3700
Practice Address - Fax:617-524-5839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA035706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty