Provider Demographics
NPI:1245253723
Name:BANEY, PHILIP JOHN IV (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:BANEY
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0796
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:31 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8778
Practice Address - Country:US
Practice Address - Phone:610-816-2170
Practice Address - Fax:610-562-9814
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD069454L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102325198Medicaid
PA102325198Medicaid