Provider Demographics
NPI:1386850832
Name:FERRARI, BIANCA (MD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:FERRARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:BFL
Other - Last Name:DE SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:22395 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2012
Practice Address - Country:US
Practice Address - Phone:941-766-7222
Practice Address - Fax:941-766-0970
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084531207R00000X
FLME131599207RH0000X, 207RH0003X, 207RX0202X
WI21752-875207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021808700Medicaid
FL021808700Medicaid