Provider Demographics
NPI:1639174410
Name:NICCOLINI, DREW G (MD)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:G
Last Name:NICCOLINI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8900
Mailing Address - Fax:978-557-8867
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8900
Practice Address - Fax:978-557-8867
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-11-19
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Provider Licenses
StateLicense IDTaxonomies
MA39361207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30261OtherHARVARD PILGRIM HEALTHCAR
0011285OtherNEIGHBORHOOD HEALTH PLAN
MA1639174410OtherAETNA HMO
MA2040646Medicaid
MA4035488OtherAETNA NON HMO
NVA54064OtherANTHEM BLUE CROSS
5919450OtherCIGNA HEALTHCARE
MA039361OtherTUFTS HEALTH PLAN
100014709OtherRAILROAD MEDICARE
MA110036482AMedicaid
MAD11109OtherBLUE CROSS BLUE SHIELD
NH00000292OtherNH MEDICAID
MA1639174410OtherFALLON COMMUNITY HEALTH PLAN
29-00574OtherEVERCARE
976795OtherNETWORK HEALTH
678810OtherHEALTHSOURCE
NH00000292OtherNH MEDICAID
29-00574OtherEVERCARE