Provider Demographics
NPI:1306021035
Name:MICHAEL J BIANCAMANO
Entity Type:Organization
Organization Name:MICHAEL J BIANCAMANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCAMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-234-7334
Mailing Address - Street 1:993 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2123
Mailing Address - Country:US
Mailing Address - Phone:508-234-7334
Mailing Address - Fax:508-234-7335
Practice Address - Street 1:993 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2123
Practice Address - Country:US
Practice Address - Phone:508-234-7334
Practice Address - Fax:508-234-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1560332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1095060001Medicare NSC
MAT58703Medicare UPIN