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NPI Code Detail

MEDICARE: DREW G. NICCOLINI M.D.

MEDICARE: DREW G. NICCOLINI 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
1207RG0100XGastroenterology Physician39361MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
9100014709OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130261OTHERMAHARVARD PILGRIM HEALTHCAR
20011285OTHERNEIGHBORHOOD HEALTH PLAN
31639174410OTHERMAAETNA HMO
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
54035488OTHERMAAETNA NON HMO
6A54064OTHERNVANTHEM BLUE CROSS
75919450OTHERCIGNA HEALTHCARE
8039361OTHERMATUFTS HEALTH PLAN
10MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11D11109OTHERMABLUE CROSS BLUE SHIELD
12MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
131639174410OTHERMAFALLON COMMUNITY HEALTH PLAN
1429-00574OTHEREVERCARE
15976795OTHERNETWORK HEALTH
16678810OTHERHEALTHSOURCE

General Provider Information

NPI Number : 1639174410
Entity Type Code : Individual
Provider Name (Legal Business Name) : DREW G. NICCOLINI M.D.
Provider Business Mailing Address
First Line : 500 MERRIMACK ST
Second Line : RIVERWALK
City : LAWRENCE
State : MA
Zip : 01843-1756
Country : US
Telephone Number : 978-557-8900
Fax Number : 978-557-8867
Provider Business Practice Location Address
First Line : 500 MERRIMACK ST
Second Line : RIVERWALK
City : LAWRENCE
State : MA
Zip : 01843-1756
Country : US
Telephone Number : 978-557-8900
Fax Number : 978-557-8867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 11/19/2012

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