MEDICARE: AMY LOUISE BIANCONE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C0000899	MD

General Provider Information

NPI Number	:	1568452100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LOUISE BIANCONE PAC

Provider Business Mailing Address
First Line	:	324 SUNSET DR
Second Line	:
City	:	LAVALE
State	:	MD
Zip	:	21502-1921
Country	:	US
Telephone Number	:	301-777-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 BISHOP WALSH RD STE 4
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1845
Country	:	US
Telephone Number	:	301-777-5326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	11/08/2022

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