Provider Demographics
NPI:1588777171
Name:SICILIAN, LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:SICILIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0520
Mailing Address - Fax:617-724-9948
Practice Address - Street 1:55 FRUIT STREET BUL 148
Practice Address - Street 2:PULMONARY AND CRITICAL CARE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-1721
Practice Address - Fax:617-724-9948
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44081207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE05689OtherBCBS MA
MA0158119Medicaid
MA044081OtherTUFTS HEALTH PLAN
MAE05689Medicare ID - Type Unspecified
MA044081OtherTUFTS HEALTH PLAN