Individual
MR. KENNETH JOHN BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSPA-C
Contact information
Practice address
111 SALEM AVENUE, SUITE 302, CARBONDALE, PA 18407-2574
(570) 282-2031
(570) 282-2534
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001023L
PA
Other
Enumeration date
05/01/2006
Last updated
03/23/2015
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