Provider Demographics
NPI:1407204571
Name:CICCO, CATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CICCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 WHITEHORSE MERCERVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3834
Mailing Address - Country:US
Mailing Address - Phone:609-587-6661
Mailing Address - Fax:
Practice Address - Street 1:1445 WHITEHORSE MERCERVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3834
Practice Address - Country:US
Practice Address - Phone:609-587-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10614800207Q00000X
PAOS019233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine