Healthcare Provider Details

I. General information

NPI: 1699735035
Provider Name (Legal Business Name): MARGARET A CICIO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

54 KING CHARLES CIR
BALTIMORE MD
21237-4130
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-4065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: