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General NPI Number Information
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NPI Number | 1104007095
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Entity Type | Organization
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Legal Business Name | EUGENE C. CICCARELLI, MD PC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 116 CAMP ST
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City | HYANNIS
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State | MA
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Zip | 02601-3008
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Country | US
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Telephone | 508-771-3203
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Fax | 508-790-1943
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Provider Business Mailing Address
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Address Line | 116 CAMP ST
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City | HYANNIS
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State | MA
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Zip | 02601-3008
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Country | US
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Telephone | 508-771-3203
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Fax | 508-790-1943
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Authorized Official
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Title or Position | PRESDIENT
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Name | EUGENE C. CICCARELLI III
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Credential | M.D.
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Telephone | 508-771-3203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25231
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License Number State | MA
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