Organization
JOHN P DICICCO JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P DICICCO JR. MD PC (OWNER)
(508) 752-3690
Entity
Organization
Contact information
Practice address
10 WINTHROP ST, WORCESTER, MA 01604
(508) 752-3690
Mailing address
10 WINTHROP ST, WORCESTER, MA 01604
(508) 752-3690
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9747079
—
MA
Enumeration date
10/03/2006
Last updated
07/17/2008
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