Provider Demographics
NPI:1427684323
Name:CICCARELLI, BRYAN THOMAS (MD, PHD, MA)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:THOMAS
Last Name:CICCARELLI
Suffix:
Gender:M
Credentials:MD, PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 PLAINSBORO RD
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1913
Mailing Address - Country:US
Mailing Address - Phone:609-853-6049
Mailing Address - Fax:609-853-7221
Practice Address - Street 1:1 PLAINSBORO RD
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1913
Practice Address - Country:US
Practice Address - Phone:609-853-6049
Practice Address - Fax:609-853-7221
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12213400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine