Individual
JOSEPH BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15769 WC MAIN ST, MIDLOTHIAN, VA 23113-7327
(804) 419-9760
Mailing address
15769 WC MAIN ST, MIDLOTHIAN, VA 23113-7327
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101284638
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2022
Last updated
03/31/2026
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