Healthcare Provider Details

I. General information

NPI: 1699745901
Provider Name (Legal Business Name): CATHERINE W PICCOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 METRO CENTER BLVD STE 2000
WARWICK RI
02886-1785
US

IV. Provider business mailing address

PO BOX 1710
VOORHEES NJ
08043-7710
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-9202
  • Fax: 401-921-9212
Mailing address:
  • Phone: 856-770-0504
  • Fax: 856-770-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number292113
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA06524300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD18243
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: