MEDICARE: DR. HENRY LOUIS SICCARDI MD, MPH

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	207R00000X	Internal Medicine Physician	083877	CT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356031686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY LOUIS SICCARDI MD, MPH

Provider Business Mailing Address
First Line	:	263 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06030-8082
Country	:	US
Telephone Number	:	860-679-4477
Fax Number	:	860-679-1025

Provider Business Practice Location Address
First Line	:	263 FARMINGTON AVENUE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1025
Country	:	US
Telephone Number	:	860-679-4477
Fax Number	:	860-679-1025

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	05/19/2026

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