Individual
KATHRYN K BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 247-0610
(401) 253-3131
Mailing address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 247-0610
(401) 253-3131
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD12307
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000032662
B/S
RI
01
—
050340866
UHC
RI
05
—
1417094
—
RI
01
—
32535
NEIGHBORHOOD HEALTH PLAN
RI
01
—
414090
BCHIP
RI
01
—
AA89360
HARVARD PILGRIM
RI
Enumeration date
01/31/2007
Last updated
12/20/2010
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