Organization
ROBERT BANCO, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J BANCO M.D. (PRESIDENT)
(617) 754-5630
Entity
Organization
Contact information
Practice address
125 PARKER HILL AVE, CONVERSE 4, ROXBURY CROSSING, MA 02120-2847
(617) 754-5630
(617) 754-5593
Mailing address
125 PARKER HILL AVE, CONVERSE 4, ROXBURY CROSSING, MA 02120-2847
(617) 754-5630
(617) 754-5593
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
59668
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006139
NHP
MA
01
—
059668
TUFTS
MA
01
—
17798
HPHC
MA
05
—
9724290
—
MA
Enumeration date
09/27/2005
Last updated
07/15/2008
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