Individual
TERRANCE EDWARD BANASZAK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4343 ALL SEASONS DR STE 160, HILLIARD, OH 43026
(614) 541-2676
(614) 541-2678
Mailing address
335 GLESSNER AVE RM 325E, MANSFIELD, OH 44903-2269
(419) 520-2495
(419) 520-2496
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
58003673
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106005
—
OH
Enumeration date
12/31/2010
Last updated
08/28/2018
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