Doctor Name: | DR. BANNISTER LEE RAINES |
NPI Number: | 1952707903 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D0017735 |
Business Practice Address: | 1325 Bedford Ave Unit 21499 Baltimore, MD - 212827525 |
Business Phone Number: | 4434157170 |
Business Fax Number: | |
Mailing Address: | 1325 Bedford Ave Unit 21499, BALTIMORE |
State: | MD |
Postal Code: | 212827525 |
Phone Number: | 4434157170 |
Fax Number: | |
NPI Enumeration Date: | 11/18/2014 |
NPI Last Update Date: | 11/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D0017735 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |