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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