Provider Demographics
NPI:1659552560
Name:RICHARD CIRELLI, MD, PC
Entity Type:Organization
Organization Name:RICHARD CIRELLI, MD, PC
Other - Org Name:SUNWEST DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CIRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-7546
Mailing Address - Street 1:955 BLACK DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1403
Mailing Address - Country:US
Mailing Address - Phone:928-445-7546
Mailing Address - Fax:928-445-7598
Practice Address - Street 1:955 BLACK DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1403
Practice Address - Country:US
Practice Address - Phone:928-445-7546
Practice Address - Fax:928-445-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207N00000X, 207NP0225X, 207NS0135X
AZAZ27370207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73665Medicare PIN