Provider Demographics
NPI:1356325773
Name:BIANCHI, EDGARDO HUGO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:HUGO
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 1:1032 W COVE LOOP
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9575
Mailing Address - Country:US
Mailing Address - Phone:910-399-6118
Mailing Address - Fax:
Practice Address - Street 1:1032 W COVE LOOP
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9575
Practice Address - Country:US
Practice Address - Phone:910-399-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890020KMedicaid