Healthcare Provider Details

I. General information

NPI: 1487651865
Provider Name (Legal Business Name): LAWRENCE PICCIONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BEISER BLVD SUITE 101
DOVER DE
19904-7790
US

IV. Provider business mailing address

260 BEISER BLVD SUITE 101
DOVER DE
19904-7790
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-8060
  • Fax: 302-730-8063
Mailing address:
  • Phone: 302-730-8060
  • Fax: 302-730-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC1003B68
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: