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Organization

EUGENE C. CICCARELLI, MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EUGENE C. CICCARELLI III M.D. (PRESDIENT)
(508) 771-3203
Entity
Organization

Contact information

Practice address
116 CAMP ST, HYANNIS, MA 02601-3008
(508) 771-3203
(508) 790-1943
Mailing address
116 CAMP ST, HYANNIS, MA 02601-3008
(508) 771-3203
(508) 790-1943

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25231
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9756175
MA
01
M12071
MA BLUE SHIELD GROUP #
MA
Enumeration date
11/19/2007
Last updated
11/19/2007
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