Healthcare Provider Details

I. General information

NPI: 1093957094
Provider Name (Legal Business Name): BRIAN A. BIANCO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARNIE BLVD STE B5
VOORHEES NJ
08043-4514
US

IV. Provider business mailing address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2742
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-7572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MB08907400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MB08907400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberOS014701
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: