Healthcare Provider Details

I. General information

NPI: 1265474696
Provider Name (Legal Business Name): FEDERAL HILL PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 QUEEN ST
BRISTOL CT
06010-6379
US

IV. Provider business mailing address

291 QUEEN ST
BRISTOL CT
06010-6379
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-1845
  • Fax:
Mailing address:
  • Phone: 860-583-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number033599
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number033599
License Number StateCT

VIII. Authorized Official

Name: ARMANN O CICCARELLI
Title or Position: PRESIDENT
Credential: MD
Phone: 860-583-1845