Provider Demographics
NPI:1073535274
Name:CICORIA, ANTHONY D (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:CICORIA
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 1:33-39 COURT ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1325
Mailing Address - Country:US
Mailing Address - Phone:607-337-4700
Mailing Address - Fax:607-334-8306
Practice Address - Street 1:33-39 COURT ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1325
Practice Address - Country:US
Practice Address - Phone:607-337-4700
Practice Address - Fax:607-334-8306
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174322-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000082021OtherGHI-HMO
201344838OtherEXCELLUS BC/BS
10032308OtherCDPHP
0598754OtherGHI-PPO
188032OtherMVP
188032OtherMVP
0598754OtherGHI-PPO
B81205Medicare UPIN
000000082021OtherGHI-HMO
RA3016Medicare ID - Type Unspecified