Individual
RAYMOND ANTHONY BANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 JACOB ST. SUITE 201, VALLEY PROF CENTER SOUTH, WHEELING, WV 26003-6390
(304) 242-9245
(304) 242-6870
Mailing address
300 WHARTON CIR, STE 120, TRIADELPHIA, WV 26059-1293
(304) 242-9245
(304) 242-6870
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
16474
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0095458000
—
WV
01
—
180012368
RAILROAD MEDICARE
WV
01
—
DG8768
RAILROAD MEDICARE GROUP
WV
Enumeration date
12/06/2006
Last updated
02/18/2020
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