Provider Demographics
NPI:1487642906
Name:PICARIELLO, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:PICARIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ARRANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2503
Mailing Address - Country:US
Mailing Address - Phone:610-363-2532
Mailing Address - Fax:610-363-0210
Practice Address - Street 1:111 ARRANDALE BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2503
Practice Address - Country:US
Practice Address - Phone:610-363-2532
Practice Address - Fax:610-363-0210
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039764E207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012509010007Medicaid
PAE83728Medicare UPIN
PA669411K61Medicare PIN