Provider Demographics
NPI:1013903590
Name:BIANCA, VINCENT CHARLES III (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:CHARLES
Last Name:BIANCA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 STRADA STELL CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4373
Mailing Address - Country:US
Mailing Address - Phone:239-597-5638
Mailing Address - Fax:239-597-5628
Practice Address - Street 1:9015 STRADA STELL CT
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4373
Practice Address - Country:US
Practice Address - Phone:239-597-5638
Practice Address - Fax:239-597-5628
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 89459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA105665OtherHIGHMARK BLUE SHIELD
PA105665OtherHIGHMARK BLUE SHIELD
B36641Medicare UPIN
FLHI066YMedicare PIN