Provider Demographics
NPI:1255478533
Name:BANKS, NIA DANIELLE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NIA
Middle Name:DANIELLE
Last Name:BANKS
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Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:325 HOSPITAL DR STE 209
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5807
Mailing Address - Country:US
Mailing Address - Phone:301-880-7022
Mailing Address - Fax:301-880-0524
Practice Address - Street 1:325 HOSPITAL DR STE 209
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5807
Practice Address - Country:US
Practice Address - Phone:301-880-7022
Practice Address - Fax:301-880-0524
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2024-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00677942086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery