1265435309 NPI number — DR. ANTHONY G CICCAGLIONE M.D.

Table of content: DR. ANTHONY G CICCAGLIONE M.D. (NPI 1265435309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265435309 NPI number — DR. ANTHONY G CICCAGLIONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CICCAGLIONE
Provider First Name:
ANTHONY
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265435309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3715 MAIN ST
Provider Second Line Business Mailing Address:
STE 408
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06606-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-371-0406
Provider Business Mailing Address Fax Number:
203-371-6206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3715 MAIN ST
Provider Second Line Business Practice Location Address:
STE 408
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-371-0406
Provider Business Practice Location Address Fax Number:
203-371-6206
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  027876 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000129874006 . This is a "UNITED" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ZP085 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 129640 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4322371 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4394341002 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001528 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 129640 . This is a "FIRSTCHOICECT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2501583 . This is a "GHI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 739792 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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