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General NPI Number Information
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NPI Number | 1093957094
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Entity Type | Individual
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Provider Name | BRIAN A. BIANCO D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 245 N 15TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1101
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Country | US
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Telephone | 215-762-1693
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Fax |
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Provider Business Mailing Address
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Address Line | 245 N 15TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1101
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Country | US
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Telephone | 215-762-1693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MB08907400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | OS014701
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License Number State | PA
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