Individual
CHARLES ANTHONY DICECCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 CONGRESS STREET, SUITE308, QUINCY, MA 02169
(617) 773-7457
(617) 773-0299
Mailing address
300 CONGRESS STREET, SUITE 308, QUINCY, MA 02169
(617) 773-7457
(617) 773-0299
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
039257
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2069237
—
MA
01
—
C20249
BCBS
MA
Enumeration date
04/22/2006
Last updated
02/15/2017
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