Healthcare Provider Details

I. General information

NPI: 1205248127
Provider Name (Legal Business Name): DR. NICHOLAS CIOTOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 MERRIMACK ST # 1B
METHUEN MA
01844-5802
US

IV. Provider business mailing address

386 MERRIMACK ST #1B
METHUEN MA
01844
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-0382
  • Fax:
Mailing address:
  • Phone: 978-682-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006784
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: