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NPI Code Detail

MEDICARE: ANDREW MICHAEL CICCARELLI M.D.

MEDICARE: ANDREW MICHAEL 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
12085R0202XDiagnostic Radiology Physician15912CWY
22085R0202XDiagnostic Radiology PhysicianME164193FL
32085R0202XDiagnostic Radiology PhysicianA90543CA
42085R0202XDiagnostic Radiology Physician2023024651MO
52085R0202XDiagnostic Radiology Physician228309MA
62085R0202XDiagnostic Radiology PhysicianMD-51377IA
72085R0202XDiagnostic Radiology PhysicianMC-155GU

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407893738
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW MICHAEL CICCARELLI M.D.
Provider Business Mailing Address
First Line : 30 LOCUST ST
Second Line :
City : NORTHAMPTON
State : MA
Zip : 01060-2052
Country : US
Telephone Number : 413-582-2000
Fax Number :
Provider Business Practice Location Address
First Line : 30 LOCUST ST
Second Line :
City : NORTHAMPTON
State : MA
Zip : 01060-2052
Country : US
Telephone Number : 413-582-2101
Fax Number : 413-582-2949
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 01/27/2026

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