MEDICARE: DR. CHRISTOPHER CICCARELLI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD468572	PA
2	207Q00000X	Family Medicine Physician	ME138213	FL

General Provider Information

NPI Number	:	1215385067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER CICCARELLI M.D.

Provider Business Mailing Address
First Line	:	65 RILEY RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5419
Country	:	US
Telephone Number	:	407-635-3022
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 RILEY RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5419
Country	:	US
Telephone Number	:	407-635-3022
Fax Number	:	321-203-4624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	07/13/2022

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