Provider Demographics
NPI:1477644946
Name:BIANCAMANO, MICHAEL JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BIANCAMANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1560213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0336211Medicaid
MA5312OtherFALLON HEALTH PLAN
MA001560OtherTUFTS HEALTH PLAN
MA2703029OtherUNITED HEALTH CARE
MAY70648OtherBLUE SHIELD OF MA
MA2700151OtherEVERCARE
MA0336211Medicaid
MA2703029OtherUNITED HEALTH CARE
MA1095060001Medicare NSC
MA5312OtherFALLON HEALTH PLAN