Provider Demographics
NPI:1851350177
Name:ROSSO, BIANCA (MD)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:ROSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4692 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3410
Mailing Address - Country:US
Mailing Address - Phone:336-251-1114
Mailing Address - Fax:336-251-1114
Practice Address - Street 1:4692 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:336-251-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-01135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1091JOtherBLUE CROSS AND BLUE SHIEL
NC891091JMedicaid
NC8917688OtherCIGNA HEALTHCARE
NC891091JMedicaid
NC8917688OtherCIGNA HEALTHCARE