Provider Demographics
NPI:1558310078
Name:BIONDI, DANIEL T (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:BIONDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 LAKE SHORE RD S
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8228
Mailing Address - Country:US
Mailing Address - Phone:704-562-1613
Mailing Address - Fax:704-658-0418
Practice Address - Street 1:2826 LAKE SHORE RD S
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8228
Practice Address - Country:US
Practice Address - Phone:704-562-1613
Practice Address - Fax:704-658-0418
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01409207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905122Medicaid
NC2058870BMedicare PIN
NC2058870AMedicare PIN