MEDICARE: ANTHONY D LOBIANCO D.O. PC

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	207Q00000X	Family Medicine Physician	OS001773L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114299609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY D LOBIANCO D.O. PC

Provider Business Mailing Address
First Line	:	826 CHRISTIAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3947
Country	:	US
Telephone Number	:	215-923-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 CHRISTIAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3947
Country	:	US
Telephone Number	:	215-923-3450
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY D LOBIANCO
Credential	:	D.O.
Telephone Number	:	215-923-3450

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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