Provider Demographics
NPI:1699902437
Name:SCIORTINO, GIORGIO BRUNO
Entity type:Individual
Prefix:MR
First Name:GIORGIO
Middle Name:BRUNO
Last Name:SCIORTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3099
Mailing Address - Country:US
Mailing Address - Phone:978-256-6500
Mailing Address - Fax:978-256-6565
Practice Address - Street 1:60 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3099
Practice Address - Country:US
Practice Address - Phone:978-256-6500
Practice Address - Fax:978-256-6565
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1873332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110076793/AMedicaid
5896490002Medicare NSC