MEDICARE: OVLETO W. 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
1	208600000X	Surgery Physician	042-0010095	VT

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

General Provider Information

NPI Number	:	1982664249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OVLETO W. CICCARELLI M.D.

Provider Business Mailing Address
First Line	:	44 S MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	VT
Zip	:	05060-1381
Country	:	US
Telephone Number	:	802-728-2430
Fax Number	:	802-728-2613

Provider Business Practice Location Address
First Line	:	44 S MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	VT
Zip	:	05060-1381
Country	:	US
Telephone Number	:	802-728-2430
Fax Number	:	802-728-2613

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	04/30/2014

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