Provider Demographics
NPI:1548847312
Name:BANAGAN, ANDREW
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BANAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 17TH ST NW APT 405
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6432
Mailing Address - Country:US
Mailing Address - Phone:404-710-6564
Mailing Address - Fax:
Practice Address - Street 1:503 FLORIDA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1850
Practice Address - Country:US
Practice Address - Phone:404-710-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70825492Medicaid