Provider Demographics
NPI:1255352472
Name:VIDYA S. BANKA M.D. ASSOCIATES PC
Entity type:Organization
Organization Name:VIDYA S. BANKA M.D. ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-333-6611
Mailing Address - Street 1:2101 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1802
Mailing Address - Country:US
Mailing Address - Phone:215-333-6611
Mailing Address - Fax:215-904-8615
Practice Address - Street 1:301 S 8TH ST
Practice Address - Street 2:DUNCAN BLDG. SUITE 2B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4000
Practice Address - Country:US
Practice Address - Phone:215-829-6369
Practice Address - Fax:215-829-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0495507000OtherKHPE
PA0012587680003Medicaid
PA29277OtherHEALTH PARTNERS
PA29277OtherHEALTH PARTNERS
PA125369KAZMedicare PIN
PA663166Medicare ID - Type Unspecified