Provider Demographics
NPI:1285601013
Name:CICCARELLI, EUGENE C (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:C
Last Name:CICCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3008
Mailing Address - Country:US
Mailing Address - Phone:508-775-5577
Mailing Address - Fax:508-790-1943
Practice Address - Street 1:116 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3008
Practice Address - Country:US
Practice Address - Phone:508-775-5577
Practice Address - Fax:508-790-1943
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25231207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9756175Medicaid
MAA59756Medicare UPIN
MA9756175Medicaid