Provider Demographics
NPI:1639219918
Name:CONTI, BIANCA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:MARIE
Last Name:CONTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4374
Mailing Address - Country:US
Mailing Address - Phone:410-328-6331
Mailing Address - Fax:410-328-1674
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:SUITE 300 6TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-6331
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0064862207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414805300Medicaid
MD414805300Medicaid