Individual
MR. UGOALA C BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
464 ATTLEBORO CT, MASON, OH 45040-2213
(513) 505-6309
(513) 486-1868
Mailing address
PO BOX 316, KINGS MILLS, OH 45034-0316
(513) 505-6309
(513) 486-1868
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
22449
WV
207RC0000X
Cardiovascular Disease Physician
Primary
127443
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001908161
WV BLUE CROSS PIN #
WA
05
—
3810006842
—
WV
01
—
520795508
TAX ID
WV
01
—
P00345268
RAILROAD MEDICARE PIN
—
Enumeration date
10/03/2006
Last updated
07/10/2023
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