Provider Demographics
NPI:1215095732
Name:PICCONE, MATTHEW J (DO, FAAP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:PICCONE
Suffix:
Gender:M
Credentials:DO, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-226-6100
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:PEDIATRICS
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-226-6100
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH13837208000000X
NHRT1602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1034003Medicaid
NH3078671Medicaid