Provider Demographics
NPI:1568460376
Name:CHIANCONE, GIANCARLO MASSIMO (MD)
Entity Type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:MASSIMO
Last Name:CHIANCONE
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 1:13950 BRANDYWINE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5815
Mailing Address - Country:US
Mailing Address - Phone:301-782-2220
Mailing Address - Fax:301-782-2221
Practice Address - Street 1:13950 BRANDYWINE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5815
Practice Address - Country:US
Practice Address - Phone:301-782-2220
Practice Address - Fax:301-782-2221
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71646207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B09494Medicare UPIN
MD1851473722OtherGROUP NPI
B09494Medicare UPIN
DC624316OtherMEDICARE GROUP