Provider Demographics
NPI:1083617211
Name:CICCIA, MARIA DEL ROSARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL ROSARIO
Last Name:CICCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:3501 JOHNSON ST FL 1
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-8000
Practice Address - Fax:954-276-0471
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME726172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255886600Medicaid
FL43718OtherBLUE CROSS BLUE SHIELD
FL43718OtherBLUE CROSS BLUE SHIELD
FL43718Medicare ID - Type Unspecified