Provider Demographics
NPI:1992723282
Name:CIANCIMINO, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:CIANCIMINO
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 1:4697 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1869
Mailing Address - Country:US
Mailing Address - Phone:203-372-5695
Mailing Address - Fax:203-459-0574
Practice Address - Street 1:4697 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1869
Practice Address - Country:US
Practice Address - Phone:203-372-5695
Practice Address - Fax:203-459-0574
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0316792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010031679CT01OtherBLUE CROSS
CT168586OtherMANAGED HEALTH NETWORK
CT134581OtherCIGNA
CTZS814OtherOXFORD
CT134581OtherCIGNA