Provider Demographics
NPI:1700836467
Name:BILANIUK, LARISSA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:T
Last Name:BILANIUK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ 9TH FLOOR
Mailing Address - Street 2:RACH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4319
Mailing Address - Country:US
Mailing Address - Phone:267-425-9200
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - RADIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-7000
Practice Address - Fax:215-590-9348
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-10-26
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Provider Licenses
StateLicense IDTaxonomies
PAMD009226E2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006953930001Medicaid
B37106Medicare UPIN
AB2502070OtherDEA
PA118593Medicare ID - Type Unspecified