Healthcare Provider Details

I. General information

NPI: 1437206562
Provider Name (Legal Business Name): NICOLE P PISCATELLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

3141 N 48TH ST
PHOENIX AZ
85018-6564
US

V. Phone/Fax

Practice location:
  • Phone: 508-859-5288
  • Fax: 508-856-4224
Mailing address:
  • Phone: 802-310-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number249491
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301106577
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number82-320
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD453740
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number47176
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number249491
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: