Organization
RAYMOND A BANNAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND ANTHONY BANNAN (OWNER)
(304) 242-9245
Entity
Organization
Contact information
Practice address
2101 JACOB ST. SUITE 201, VALLEY PROF. CENTER SOUTH, WHEELING, WV 26003-3800
(304) 242-9245
(304) 242-6870
Mailing address
2101 JACOB ST. SUITE 201, VALLEY PROF. CENTER SOUTH, WHEELING, WV 26003-3800
(304) 242-9245
(304) 242-6870
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
16474
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009548000
—
WV
01
—
180012368
RAILROAD MEDICARE
WV
01
—
DG8768
RAILROAD MEDICARE GRP
WV
Enumeration date
12/13/2006
Last updated
05/04/2011
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