Provider Demographics
NPI:1710947379
Name:CICCARELLI, ARMANN O (MD)
Entity Type:Individual
Prefix:
First Name:ARMANN
Middle Name:O
Last Name:CICCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:VT
Mailing Address - Zip Code:05774-0778
Mailing Address - Country:US
Mailing Address - Phone:860-485-5892
Mailing Address - Fax:
Practice Address - Street 1:35 E 38TH ST APT 10G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2524
Practice Address - Country:US
Practice Address - Phone:860-485-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176807208600000X, 2086S0122X, 208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001335993-00OtherBLUECARE FAMILY PLAN
CT06146749-005OtherCIGNA
CTHAS 347OtherOXFORD
CT2379784OtherAETNA HMO
CTOR2731OtherHEALTHNET
CT769115OtherCONNECTICARE
CT010033599CT01OtherANTHEM BC\BS
CT4512806OtherAETNA US HEALTHCARE
CT06146749-005OtherCIGNA