Individual
MRS. IVONA M BANHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2700 QUARRY LAKE DR STE 300, BALTIMORE, MD 21209-3746
(410) 768-5555
Mailing address
2700 QUARRY LAKE DR STE 300, BALTIMORE, MD 21209-3746
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0000856
MD
363AS0400X
Surgical Physician Assistant
C00856
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN6601
R/R MEDICARE GROUP #
MD
01
—
P00141770
R/R MEDICARE PROVIDER #
MD
Enumeration date
03/28/2006
Last updated
05/24/2022
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