Provider Demographics
NPI:1437206562
Name:PISCATELLI, NICOLE P (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:P
Last Name:PISCATELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3141 N 48TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6564
Mailing Address - Country:US
Mailing Address - Phone:802-310-9302
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-859-5288
Practice Address - Fax:508-856-4224
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2494912086S0102X, 2086S0127X
MI43011065772086S0102X
WI82-3202086S0127X
PAMD4537402086S0127X
AZ471762086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care