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General NPI Number Information
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NPI Number | 1740471903
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Entity Type | Individual
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Provider Name | VITALIANO SICILIA MD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 240 S MAIN ST
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City | WOLFEBORO
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State | NH
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Zip | 03894-4455
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Country | US
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Telephone | 603-569-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 199 UNION AVE APT 1G
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City | RUTHERFORD
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State | NJ
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Zip | 07070-3504
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Country | US
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Telephone | 646-755-0994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042.0011767
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License Number State | VT
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