Healthcare Provider Details

I. General information

NPI: 1508851601
Provider Name (Legal Business Name): ROBERT CICCHELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E MAIN RD STE 19A
MIDDLETOWN RI
02842-4957
US

IV. Provider business mailing address

10 DAVOL SQ SUITE 400
PROVIDENCE RI
02903-4754
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-0055
  • Fax: 401-842-0963
Mailing address:
  • Phone: 401-421-4000
  • Fax: 401-272-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD09279
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: