Provider Demographics
NPI:1376501148
Name:BIANCHI, HENRY EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:EDWARD
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:PO BOX 36207
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6207
Mailing Address - Country:US
Mailing Address - Phone:520-577-3333
Mailing Address - Fax:520-577-4685
Practice Address - Street 1:4930 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718
Practice Address - Country:US
Practice Address - Phone:520-577-3333
Practice Address - Fax:520-577-4685
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15902208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ257932Medicaid