Healthcare Provider Details

I. General information

NPI: 1740484211
Provider Name (Legal Business Name): THOMAS D BIANCHI M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HERREN HILL RD SUITE E
TALLASSEE AL
36078-1263
US

IV. Provider business mailing address

80 HERREN HILL RD SUITE E
TALLASSEE AL
36078-1263
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-3862
  • Fax: 334-283-3871
Mailing address:
  • Phone: 334-283-3862
  • Fax: 334-283-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8344
License Number StateAL

VIII. Authorized Official

Name: DR. THOMAS D BIANCHI
Title or Position: OWNER
Credential: M.D.
Phone: 334-283-3862