Healthcare Provider Details

I. General information

NPI: 1538645999
Provider Name (Legal Business Name): DEANNA MARGARET BIANCHINI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 EAGLEVIEW BLVD
EXTON PA
19341-1157
US

IV. Provider business mailing address

1657 THAYER DR
BLUE BELL PA
19422-3548
US

V. Phone/Fax

Practice location:
  • Phone: 610-561-6400
  • Fax: 610-561-6401
Mailing address:
  • Phone: 215-589-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059909
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMA059909
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: