Charles J. Bannon, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD028552L Issued in PA

Practice address

746 Jefferson Ave
The Wound Center
Scranton, PA 18510-1624

Phone

(570) 340-5824

Fax

(570) 340-5844

NPI assigned

May 25, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Vascular Diagnostic Center PC

  • Vascular & Interventional Radiology Physician
  • Scranton, PA
  • NPI 1255308441
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250985600000",
    "number": "1366498198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "746 JEFFERSON AVE",
            "address_2": "THE WOUND CENTER",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185101921",
            "telephone_number": "570-340-5824",
            "fax_number": "570-340-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "746 JEFFERSON AVE",
            "address_2": "THE WOUND CENTER",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185101624",
            "telephone_number": "570-340-5824",
            "fax_number": "570-340-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNON",
        "first_name": "CHARLES",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2009-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD028552L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Baltrusaitis, PCD
• Colleen Kearns Baltrusaltis
• Lorraine L Banko, CRNP
• Samantha Banks
• John Glenn Bankus, DPT
• Joseph Patrick Bannon, M.D.
• Nidhi Bansal, MD
• Rajiv Varun Bansal, MD
• Cheryl Ann Banull
• Charles N. Barax, MD

• Surgery Physician in Scranton, PA
• Providers in Scranton, PA by specialty
• Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2009; 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.