Individual
OVLETO W. CICCARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44 S MAIN ST, RANDOLPH, VT 05060-1381
(802) 728-2430
(802) 728-2613
Mailing address
44 S MAIN ST, RANDOLPH, VT 05060-1381
(802) 728-2430
(802) 728-2613
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
042-0010095
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013959
—
VT
Enumeration date
03/23/2006
Last updated
04/30/2014
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