Provider Demographics
NPI:1306818232
Name:BIANCHI, THOMAS DEVERELL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DEVERELL
Last Name:BIANCHI
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 1:80 HERREN HILL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1263
Mailing Address - Country:US
Mailing Address - Phone:334-283-3862
Mailing Address - Fax:
Practice Address - Street 1:80 HERREN HILL RD
Practice Address - Street 2:SUITE E
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1263
Practice Address - Country:US
Practice Address - Phone:334-283-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8344207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51509833OtherBLUE CROSS OF ALABAMA
AL529912510Medicaid
AL529912510Medicaid
AL51509833OtherBLUE CROSS OF ALABAMA