Provider Demographics
NPI:1881655942
Name:BIANCO, TERESA IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:IRENE
Last Name:BIANCO
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-320-7525
Practice Address - Fax:570-320-7484
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4174202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1315333OtherHIGHMARK BLUE SHIELD
PA0018595800001Medicaid
PA153640OtherVALUE OPTIONS
PA813859OtherFIRST PRIORITY HEALTH
PAH32152OtherHEALTHAMERICA
PA0018595800001Medicaid
PA1315333OtherHIGHMARK BLUE SHIELD
PA053244Medicare PIN