Individual
DR. BETHANY TARA SAMUELSON BANNOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MCR
Contact information
Practice address
10201 CARNEGIE AVE, CLEVELAND, OH 44106-2130
(866) 223-8100
Mailing address
3096 NW PARKHURST TER, PORTLAND, OR 97229-4078
(509) 551-6258
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
35.154541
OH
207RH0000X
Hematology (Internal Medicine) Physician
OR186355
OR
207RH0003X
Hematology & Oncology Physician
Primary
35.154541
OH
Other
Enumeration date
04/12/2011
Last updated
10/07/2025
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