Provider Demographics
NPI:1720485030
Name:BANKS, MALCOLM JR
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:BANKS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 ALLENTOWN RD
Mailing Address - Street 2:107
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4521
Mailing Address - Country:US
Mailing Address - Phone:240-464-4988
Mailing Address - Fax:
Practice Address - Street 1:5625 ALLENTOWN RD
Practice Address - Street 2:107
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4521
Practice Address - Country:US
Practice Address - Phone:240-464-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator