MEDICARE: JOHN NICEFORO MD

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	2085R0202X	Diagnostic Radiology Physician	9427	NH
2	2085R0202X	Diagnostic Radiology Physician	73083	MA
3	2085R0202X	Diagnostic Radiology Physician	67572	CT

Other Identifiers

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

General Provider Information

NPI Number	:	1710972518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NICEFORO MD

Provider Business Mailing Address
First Line	:	113 CASTLE HILL RD
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-1747
Country	:	US
Telephone Number	:	978-835-8042
Fax Number	:	603-880-3099

Provider Business Practice Location Address
First Line	:	113 CASTLE HILL RD
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-1747
Country	:	US
Telephone Number	:	978-835-8042
Fax Number	:	603-880-3099

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	05/14/2021

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