MEDICARE: DANIEL T. BIONDI D.O.

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	2006-01409	NC

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	:	1558310078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL T. BIONDI D.O.

Provider Business Mailing Address
First Line	:	2826 LAKE SHORE RD S
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8228
Country	:	US
Telephone Number	:	704-562-1613
Fax Number	:	704-658-0418

Provider Business Practice Location Address
First Line	:	2826 LAKE SHORE RD S
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8228
Country	:	US
Telephone Number	:	704-562-1613
Fax Number	:	704-658-0418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/30/2016

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