Provider Demographics
NPI:1528204005
Name:LAURIE A FARRICIELLI MD, PC
Entity Type:Organization
Organization Name:LAURIE A FARRICIELLI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARRICIELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-860-0935
Mailing Address - Street 1:P.O. BOX 14406
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4406
Mailing Address - Country:US
Mailing Address - Phone:480-860-0935
Mailing Address - Fax:480-860-6569
Practice Address - Street 1:6360 E. THOMAS RD.
Practice Address - Street 2:#218
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7054
Practice Address - Country:US
Practice Address - Phone:480-860-0935
Practice Address - Fax:480-860-6569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURIE A. FARRICIELLI MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21865111NI0900X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172370Medicaid
E47421Medicare UPIN