Provider Demographics
NPI:1053388959
Name:BANNON, PATRICIA ZITA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ZITA
Last Name:BANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 GATEHOUSE RD
Mailing Address - Street 2:STE 300W
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1253
Mailing Address - Country:US
Mailing Address - Phone:703-978-1196
Mailing Address - Fax:703-978-7762
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-748-9880
Practice Address - Fax:703-748-7123
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101230750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541907692Other1
00A680W10Medicare ID - Type Unspecified