Provider Demographics
NPI:1487659801
Name:BANNING, SCOTT J (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:BANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:12655 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2501
Practice Address - Country:US
Practice Address - Phone:757-595-9880
Practice Address - Fax:757-595-0362
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101048645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080127507OtherRR/MEDICARE
VA250450OtherANTHEM PROVIDER NUMBER
VA233415OtherMAMSI PROV #
VA5606225Medicaid
VA0102024OtherUHC
VA0102024OtherUHC
VA233415OtherMAMSI PROV #