Provider Demographics
NPI:1275727737
Name:ROBERT C. BIANCO, MD, PA
Entity Type:Organization
Organization Name:ROBERT C. BIANCO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-446-2305
Mailing Address - Street 1:14 OFFICE PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3864
Mailing Address - Country:US
Mailing Address - Phone:386-446-2305
Mailing Address - Fax:386-446-1043
Practice Address - Street 1:14 OFFICE PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3864
Practice Address - Country:US
Practice Address - Phone:386-446-2305
Practice Address - Fax:386-446-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057906207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU10569OtherBCBS OF FLORIDA
FLE60659Medicare UPIN
GU10569OtherBCBS OF FLORIDA