Provider Demographics
NPI:1154672152
Name:CICCONE, MARCIA AMELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:AMELIA
Last Name:CICCONE
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 1:1516 SAN PABLO ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5313
Mailing Address - Country:US
Mailing Address - Phone:323-865-3922
Mailing Address - Fax:323-865-0062
Practice Address - Street 1:1808 VERDUGO BLVD STE 413
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1468
Practice Address - Country:US
Practice Address - Phone:818-658-5980
Practice Address - Fax:323-865-0062
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122851207VX0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology