Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 59668 | MA |
NPI | 1265434948 |
---|---|
Provider Name | Robert J Banco |
First Address | Woburn, MA 01888-4110 |
Second Address | Newton, MA 02458-1612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 02/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3043053 | (05) | MA |
B75001 | (02) | MA |