Individual provider · NPI-1

Reyadh David Al-Banna, PA-C

Physician Assistant · Glen Burnie, MD

NPI number1043647589
StatusActive
Last updated in NPPESJul 6, 2015

Details

NPI
1043647589
Entity type
Individual (NPI-1)
Name
Mr. Reyadh David Al-Banna
Credential
PA-C
Sex
Male
Sole proprietor
No
Enumeration date
Sep 30, 2013
Last updated
Jul 6, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantC0005157MDYes

Practice location

301 Hospital Dr
Suite 802
Glen Burnie, MD 21061-5803

Phone 410-553-8290 · Fax 410-553-8288

Mailing address

301 Hospital Dr
Suite 802
Glen Burnie, MD 21061-5803

Phone 410-553-8290 · Fax 410-553-8288

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