Healthcare Provider Details

I. General information

NPI: 1649266313
Provider Name (Legal Business Name): ALDO ANTHONY CICCOTELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CORPORATE DR E
LANGHORNE PA
19047-8005
US

IV. Provider business mailing address

106 CORPORATE DR E
LANGHORNE PA
19047-8005
US

V. Phone/Fax

Practice location:
  • Phone: 215-504-5253
  • Fax: 215-504-9037
Mailing address:
  • Phone: 215-504-5253
  • Fax: 215-504-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD037767E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: