1649355991 NPI number — DR. RICHARD MICHAEL BIANCO DO

Table of content: DR. RICHARD MICHAEL BIANCO DO (NPI 1649355991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649355991 NPI number — DR. RICHARD MICHAEL BIANCO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIANCO
Provider First Name:
RICHARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649355991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 BULLOCKS POINT AVE APT 6B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02915-5373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-439-6787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 VETERANS MEMORIAL PKWY UNIT 15B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-434-3350
Provider Business Practice Location Address Fax Number:
401-434-5230
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  00313 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005251176 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9003033 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4136 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA97197 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1711103 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3033 . This is a "BCBS RIBS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 404250 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




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