Provider Demographics
NPI:1992888341
Name:BIANCULLI, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:BIANCULLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2117
Mailing Address - Country:US
Mailing Address - Phone:412-406-7727
Mailing Address - Fax:412-371-3931
Practice Address - Street 1:3 SHADOW LN
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2117
Practice Address - Country:US
Practice Address - Phone:412-406-7727
Practice Address - Fax:312-371-3931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP 026069 L183500000X
PARP026069L183500000X
PAXD039872L2083A0300X
PAMD 039872 L208600000X
PAMD039872L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No183500000XPharmacy Service ProvidersPharmacist
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1127013Medicaid
PABI 188011Medicare ID - Type Unspecified
PA1127013Medicaid