DRS BIONDO & SIM PA

Provider Demographics

• NPI: 1841479938
• Name: DRS BIONDO & SIM PA
• Entity type: Organization
• Organization Name: DRS BIONDO & SIM PA
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: OFFICE MANAGER
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: SANDRA
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: GALLION
• Authorized Official - Phone: 410-939-4477
• Mailing Address - Street 1: 251 LEWIS LN
• Mailing Address - Street 2: SUITE 201
• Mailing Address - City: HAVRE DE GRACE
• Mailing Address - State: MD
• Mailing Address - Zip Code: 21078-3751
• Mailing Address - Country: US
• Mailing Address - Phone: 410-939-4477
• Mailing Address - Fax: 410-939-1153
• Practice Address - Street 1: 251 LEWIS LANE
• Practice Address - Street 2: SUITE 201
• Practice Address - City: HAVRE DE GRACE
• Practice Address - State: MD
• Practice Address - Zip Code: 21078-3753
• Practice Address - Country: US
• Practice Address - Phone: 410-939-4477
• Practice Address - Fax: 410-939-1153
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-10-25
• Last Update Date: 2009-03-13

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	173000000X	Other Service Providers	Legal Medicine		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	000424675	Other	BS OF PA
MD	145388000	Other	WORKMENS COMPENSATION DEPARTMENT OF LABOR
MD	148241600	Medicaid
MD	408544200	Medicaid
MD	348561700	Medicaid
MD	W724001	Other	DELMARVA HEALTH PLAN
MD	K781UN	Other	BLUE SHIELD OF MARYLAND
MD	982961000	Medicaid
DC	W724001	Other	BLUE SHIELD DC
MD	982961000	Medicaid
	I15262	Medicare UPIN
MD	K781UN	Other	BLUE SHIELD OF MARYLAND
PA	000424675	Other	BS OF PA
MD	I42208	Medicare UPIN
	K781LV29	Medicare PIN
	K781BK46	Medicare PIN
MD	348561700	Medicaid