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NPI Code Detail

MEDICARE: MICHAEL GIRARD CICCOTTI M.D.

MEDICARE: MICHAEL GIRARD CICCOTTI M.D.
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
1207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianMD040661EPA
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician25MA06744600NJ
3207X00000XOrthopaedic Surgery PhysicianMD040661EPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10116226OTHERPAAETNA
20529117000OTHERPAIBC
31260028OTHERCIGNA

General Provider Information

NPI Number : 1245287556
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL GIRARD CICCOTTI M.D.
Provider Business Mailing Address
First Line : 833 CHESTNUT ST STE 520
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19107-4430
Country : US
Telephone Number : 609-677-7003
Fax Number : 267-339-3761
Provider Business Practice Location Address
First Line : 833 CHESTNUT ST STE 1220
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19107-4413
Country : US
Telephone Number : 800-321-9999
Fax Number : 267-479-1321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 06/27/2025

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Directions to “ MICHAEL GIRARD CICCOTTI M.D.” Practice Location

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