Provider Demographics
NPI:1083601108
Name:BIANCARELLI, GEORGE ANGELO (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANGELO
Last Name:BIANCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-1663
Mailing Address - Country:US
Mailing Address - Phone:406-434-3100
Mailing Address - Fax:406-434-3143
Practice Address - Street 1:670 PARK AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1663
Practice Address - Country:US
Practice Address - Phone:406-434-3100
Practice Address - Fax:406-434-3143
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000084907Medicare PIN