Basic Information
| Provider Information | |||||||||
| NPI: | 1235397167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CICCHINO | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2217 BRISTOL PIKE | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190205720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156380555 | ||||||||
| FaxNumber: | 2156382929 | ||||||||
| Practice Location | |||||||||
| Address1: | 2217 BRISTOL PIKE | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190205720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156380555 | ||||||||
| FaxNumber: | 2156382929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34.009317 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | OS015576 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.