Marc P Banner, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD013382E Issued in PA

Practice address

3400 Spruce Street
Ground Floor Dulles
Philadelphia, PA 19104

Phone

(215) 662-3000

Fax

(215) 662-7011

NPI assigned

Jun 27, 2006

Last updated

Jan 24, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Trustees of the University of Pennsylvania

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1124882949
  NPD (past)
• Univ of Penn Community Radiology

  • Diagnostic Radiology Physician
  • Wayne, PA
  • NPI 1740293232
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1356378244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "GROUNDS FLOOR DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "GROUND FLOOR DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3000",
            "fax_number": "215-662-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNER",
        "first_name": "MARC",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD013382E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006953390008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pradeep R. Bankulla, MD
• Theresa Banmeke, CRNP
• Amr Bannan, MD
• Banner Care LLC
• David W Banner, MD
• Ronald Stuart Banner, MD
• Ashley Sarah Bannerman-Martin, CRNP
• Andrea Bannon, CRNP
• Pamela Dorothy Bannon, MD
• Shane Bannon

• Diagnostic Radiology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Diagnostic Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.