Provider Demographics
NPI:1548540578
Name:BRANCH, EMERALD ROSE BANAS (MD)
Entity type:Individual
Prefix:DR
First Name:EMERALD ROSE
Middle Name:BANAS
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMERALD
Other - Middle Name:ROSE
Other - Last Name:BANAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 EAST GREENVILLE ST., SUITE 1100
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-225-5667
Mailing Address - Fax:864-716-6746
Practice Address - Street 1:2000 EAST GREENVILLE ST., SUITE 1100
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-225-5667
Practice Address - Fax:864-716-6746
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37829MD207R00000X
390200000X
SC37829207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC378291Medicaid