MEDICARE: GIANCARLO MASSIMO CHIANCONE MD

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	207Y00000X	Otolaryngology Physician	D71646	MD

General Provider Information

NPI Number	:	1568460376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIANCARLO MASSIMO CHIANCONE MD

Provider Business Mailing Address
First Line	:	13950 BRANDYWINE RD
Second Line	:	SUITE 150
City	:	BRANDYWINE
State	:	MD
Zip	:	20613-5815
Country	:	US
Telephone Number	:	301-782-2220
Fax Number	:	301-782-2221

Provider Business Practice Location Address
First Line	:	13950 BRANDYWINE RD
Second Line	:	SUITE 150
City	:	BRANDYWINE
State	:	MD
Zip	:	20613-5815
Country	:	US
Telephone Number	:	301-782-2220
Fax Number	:	301-782-2221

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/21/2016

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