Individual
KENNETH J BANASIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
282 WASHINGTON ST, HARTFORD, CT 06106-3322
(860) 545-9850
(860) 545-8812
Mailing address
301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-7609
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
017898
ME
2080P0203X
Pediatric Critical Care Medicine Physician
035451
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001354513
—
CT
05
—
30208101
—
NH
05
—
433063199
—
ME
Enumeration date
11/17/2005
Last updated
09/09/2022
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