Provider Demographics
NPI:1063425437
Name:BANNING, TODD RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:RICHARD
Last Name:BANNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 BLAKESLEE BOULEVARD DR E
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2401
Mailing Address - Country:US
Mailing Address - Phone:570-386-6900
Mailing Address - Fax:570-386-6901
Practice Address - Street 1:1241 BLAKESLEE BOULEVARD DR E
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2401
Practice Address - Country:US
Practice Address - Phone:570-386-6900
Practice Address - Fax:570-386-6901
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008961-L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018106500001Medicaid
PAH16825Medicare UPIN
PA0018106500001Medicaid