Provider Demographics
NPI:1699821009
Name:CICENIA, JOSEPH C III (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:CICENIA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:A90
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-8606
Mailing Address - Fax:216-445-0474
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:A90
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-8606
Practice Address - Fax:216-445-0474
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY217694207RP1001X
OH35.096266207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY217694OtherSTATE MEDICAL LICENCE #
OH35.096266OtherOHIO MEDICAL LICENSE
NY02094631Medicaid
NY02094631Medicaid
NYBC5705477OtherDEA NUMBER
H23608Medicare UPIN