Healthcare Provider Details

I. General information

NPI: 1902803430
Provider Name (Legal Business Name): MICHAEL A MARCIELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ASYLUM ST
MILFORD MA
01757-2203
US

IV. Provider business mailing address

14 ASYLUM ST
MILFORD MA
01757-2203
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-5500
  • Fax: 508-478-6247
Mailing address:
  • Phone: 508-473-5500
  • Fax: 508-478-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number152314
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: