Provider Demographics
NPI:1235362807
Name:NIA D. BANKS, MD, PHD, LLC
Entity type:Organization
Organization Name:NIA D. BANKS, MD, PHD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-880-7022
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty