Provider Demographics
NPI:1093717324
Name:DICICCO, BARRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:DICICCO
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 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:STE 307
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1715
Mailing Address - Country:US
Mailing Address - Phone:703-391-8804
Mailing Address - Fax:703-391-5659
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 307
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1715
Practice Address - Country:US
Practice Address - Phone:703-391-8804
Practice Address - Fax:703-391-5659
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032333207RC0200X, 207RP1001X
SC89292207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6064329Medicaid
B94865Medicare UPIN
DC426764Medicare PIN