Individual
DEAN A. SICILIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5289
(740) 446-5697
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5289
(740) 446-5697
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
20136
WV
2085R0202X
Diagnostic Radiology Physician
Primary
35-07-0141
OH
2085R0204X
Vascular & Interventional Radiology Physician
20136
WV
2085R0204X
Vascular & Interventional Radiology Physician
35-070141
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007131
ANTHEM BCBS
—
01
—
000000193128
UNISON MEDICAID #
OH
01
—
001714093
MOUNTAIN STATE BCBS
—
05
—
0122089000
—
WV
01
—
0247674
MOLINA MEDICAID #
OH
01
—
300071295
RR MEDICARE
OH
01
—
310917085031
OH MEDICAID CARESOURCE
OH
Enumeration date
06/08/2006
Last updated
12/04/2020
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