Individual
DR. DEBRA L. MONTICCIOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-0001
(603) 650-5000
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24360
NH
2085R0202X
Diagnostic Radiology Physician
L3405
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477820-01
—
TX
01
—
1477820-02
CSHCN
TX
01
—
300127572
RR/MEDICARE
TX
01
—
8B4709
BLUE SHIELD
TX
Enumeration date
03/30/2006
Last updated
08/18/2023
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