Individual
MAUREEN THERESA BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N VAN DORN ST STE 102, ALEXANDRIA, VA 22302-1601
(703) 933-0555
Mailing address
6609 32ND ST NW, WASHINGTON, DC 20015-2309
(301) 922-0522
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101057222
VA
208000000X
Pediatrics Physician
D0092143
MD
Other
Enumeration date
10/23/2006
Last updated
11/19/2022
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