Provider Demographics
NPI:1255496089
Name:FICHERA, ALESSANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ALESSANDRO
Middle Name:
Last Name:FICHERA
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 1:3409 WORTH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2042
Mailing Address - Country:US
Mailing Address - Phone:469-800-7180
Mailing Address - Fax:
Practice Address - Street 1:3409 WORTH ST STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2042
Practice Address - Country:US
Practice Address - Phone:469-800-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60276057208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0296467OtherL&I
WA1255496089Medicaid
WA0296467OtherL&I