Provider Demographics
NPI:1396717898
Name:BANE, DENIS M (MD)
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:M
Last Name:BANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:106 S CLAUDE A LORD BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3637
Mailing Address - Country:US
Mailing Address - Phone:570-622-4209
Mailing Address - Fax:570-622-1386
Practice Address - Street 1:106 S CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3637
Practice Address - Country:US
Practice Address - Phone:570-622-4209
Practice Address - Fax:570-622-1386
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-05-18
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Provider Licenses
StateLicense IDTaxonomies
PAMD011754E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000148034OtherBLUE SHIELD
PA0473231OtherUS HEALTHCARE
PA110201291OtherRAILROAD MEDICARE PBA
PA0006942510004Medicaid
PA0064387000OtherBLUE CROSS PERSONAL CHOICE
PA01164201OtherCAPITAL BLUE CROSS
PA020301000OtherFEDERAL BLACK LUNG
PA19928OtherGEISINGER HEALTH PLAN
PA116993900OtherFEDERAL EMPLOYEES COMP
PA01164201OtherKEYSTONE
PA0998130OtherKEYSTONE SPECIALIST
PA01164201OtherKEYSTONE
PA110201291OtherRAILROAD MEDICARE PBA