Provider Demographics
NPI:1164825568
Name:BIANCO, MARTA (PAC)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:BIANCO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:OZGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 SOLSTICE CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5230
Mailing Address - Country:US
Mailing Address - Phone:718-510-7972
Mailing Address - Fax:
Practice Address - Street 1:2800 BLUE RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6476
Practice Address - Country:US
Practice Address - Phone:919-784-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
NC0010-12453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical