Organization
RAYMOND A BANNAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND ANTHONY BANNAN (OWNER)
(740) 676-1121
Entity
Organization
Contact information
Practice address
3372 BELMONT ST, BELLAIRE, OH 43906-1523
(740) 676-1121
Mailing address
3372 BELMONT ST, BELLAIRE, OH 43906-1523
(740) 676-1121
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35 054143
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0819930
—
OH
01
—
180012369
RAILROAD MEDICARE
OH
01
—
DG5587
RAILROAD MEDICARE GROUP
OH
Enumeration date
12/13/2006
Last updated
02/15/2011
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