Provider Demographics
NPI:1740363407
Name:BANACH, ANNE MARCIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARCIA
Last Name:BANACH
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:250 PLEASANT STREET
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-225-2711
Mailing Address - Fax:603-224-6527
Practice Address - Street 1:250 PLEASANT STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-2711
Practice Address - Fax:603-224-6527
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH0102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002088Medicaid
ME433563699Medicaid
NH30002088Medicaid
NHAP0925Medicare PIN