Healthcare Provider Details

I. General information

NPI: 1659552560
Provider Name (Legal Business Name): RICHARD CIRELLI, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 BLACK DR
PRESCOTT AZ
86305-1403
US

IV. Provider business mailing address

955 BLACK DR
PRESCOTT AZ
86305-1403
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-7546
  • Fax: 928-445-7598
Mailing address:
  • Phone: 928-445-7546
  • Fax: 928-445-7598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberAZ27370
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: RICHARD ALLEN CIRELLI
Title or Position: OWNER
Credential: M.D.
Phone: 928-445-7546