MEDICARE: DR. ANNE PICCIANO 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	25MA05211500	NJ
2	207Q00000X	Family Medicine Physician	MD475351	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	226019101	OTHER	NJ	HORIZON BC BS
2	5775515	OTHER	NJ	AETNA US HEALTHCARE
3	1028368	OTHER	NJ	HORIZON NJ HEALTH
4	182856001	OTHER	NJ	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1649332081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE PICCIANO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 NORTHAMPTON ST STE 130
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-2764
Country	:	US
Telephone Number	:	484-591-7420
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	12/01/2021

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