Provider Demographics
NPI:1962407924
Name:BANSON, FELICE L (MD)
Entity type:Individual
Prefix:DR
First Name:FELICE
Middle Name:L
Last Name:BANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3700 JOSEPH SIEWICK DR STE 308
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1739
Mailing Address - Country:US
Mailing Address - Phone:703-698-8960
Mailing Address - Fax:703-716-8703
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 308
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:647-646-4744
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235927207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3561431OtherAETNA HMO
VA92130007OtherCAREFIRST NETWORK
VA010053927Medicaid
VA2223019OtherFIRST HEALTH
VA665965OtherNATIONAL CAPITOL PPO
VA01456OtherUNITED HEALTHCARE
VA541604636OtherCHOICECARE NETWORK
VA139035OtherANTHEM/WARRENTON
VA2127975OtherMAMSI
VA245066OtherKAISER
VA378187001OtherCIGNA
VA541604636OtherUNICARE
VA541604636OtherVIRGINIA HEALTH NETWORK
VA7387549OtherAETNA PPO
VA139034OtherANTHEM/MANASSAS
VA245066OtherKAISER
VA541604636OtherCHOICECARE NETWORK