Provider Demographics
NPI:1912141201
Name:BANAR, MARIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:BANAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MASHA
Other - Middle Name:
Other - Last Name:BANAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:152 BARHAM AVE
Mailing Address - Street 2:APT.3
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1100
Mailing Address - Country:US
Mailing Address - Phone:617-501-7055
Mailing Address - Fax:
Practice Address - Street 1:152 BARHAM AVE
Practice Address - Street 2:APT.3
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-1100
Practice Address - Country:US
Practice Address - Phone:617-501-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2266363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical