Individual
JACOB DAL-BIANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, YAWKEY 5A, BOSTON, MA 02114-2621
(617) 724-2076
(617) 643-3963
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-2076
(617) 643-3963
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
253818
MA
207RC0000X
Cardiovascular Disease Physician
Primary
253818
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110094427/A
—
MA
05
—
612935000
—
MN
Enumeration date
08/05/2006
Last updated
03/08/2013
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