Individual
MARY E. BANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9000 N MAIN ST, ENGLEWOOD, OH 45415-1180
(937) 433-7536
(937) 433-9612
Mailing address
9000 N. MAIN ST., STE. 321, DAYTON, OH 45429-1185
(937) 836-0500
(937) 836-0636
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35080354B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070017198
RAILROAD MEDICARE
OH
01
—
3109647743A22
ANTHEM BLUE SHIELD
OH
01
—
D80354
HUMANA CHOICE CARE
OH
Enumeration date
07/17/2006
Last updated
06/08/2017
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