Individual
DR. TOLLESE H BANKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
404 EAST CHARLES STREET, 2ND FLOOR, LAPLATA, MD 20646-3946
(301) 934-9391
(301) 934-5439
Mailing address
404 EAST CHARLES STREET, 2ND FLOOR, LAPLATA, MD 20646-3946
(301) 934-9391
(301) 934-5439
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D0043965
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202141200
—
MD
Enumeration date
10/19/2010
Last updated
10/19/2010
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