Provider Demographics
NPI:1619068301
Name:BIANCO, PETER M (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:BIANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 N UNION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2051
Mailing Address - Country:US
Mailing Address - Phone:719-598-0500
Mailing Address - Fax:719-268-6834
Practice Address - Street 1:5333 N UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2051
Practice Address - Country:US
Practice Address - Phone:719-598-0500
Practice Address - Fax:719-268-6834
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27337207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01273374Medicaid
D24926Medicare UPIN
CO01273374Medicaid