Basic Information
| Provider Information | |||||||||
| NPI: | 1518022441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | VINCENT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072837000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 HEALTHCARE DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072824270 | ||||||||
| FaxNumber: | 2072827350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 10/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | NH 9297 | NH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 017426 | ME | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0105587Y0NH01 | 01 | NH | ANTHEM | OTHER | 889985 | 01 | NH | MVP HEALTHCARE | OTHER | P00120288 | 01 | NH | TRAVELERS | OTHER |