Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD-04125-E | PA |
N | 208600000X | Surgeon | MD-04125-E | PA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD041256E | PA |
NPI | 1194756320 |
---|---|
Provider Name | Dr. Dennis Ray Banducci |
First Address | Danville, PA 17822-4903 |
Second Address | Harrisburg, PA 17110-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 30/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001127882004 | (05) | PA |
E64024 | (02) | PA |