Provider Demographics
NPI:1407186190
Name:CHICARILLI, DAMIEN M (PA)
Entity Type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:M
Last Name:CHICARILLI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RICHMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2515
Mailing Address - Country:US
Mailing Address - Phone:516-312-6671
Mailing Address - Fax:
Practice Address - Street 1:23 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2515
Practice Address - Country:US
Practice Address - Phone:516-312-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0094491363AS0400X
CT002389363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical