Provider Demographics
NPI:1740484211
Name:THOMAS D BIANCHI M.D.P.A.
Entity type:Organization
Organization Name:THOMAS D BIANCHI M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-283-3862
Mailing Address - Street 1:80 HERREN HILL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1263
Mailing Address - Country:US
Mailing Address - Phone:334-283-3862
Mailing Address - Fax:334-283-3871
Practice Address - Street 1:80 HERREN HILL RD
Practice Address - Street 2:SUITE E
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1263
Practice Address - Country:US
Practice Address - Phone:334-283-3862
Practice Address - Fax:334-283-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8344207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912510Medicaid
AL529912510Medicaid
ALC73047Medicare UPIN