Provider Demographics
NPI:1710972518
Name:NICEFORO, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NICEFORO
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 1:113 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1747
Mailing Address - Country:US
Mailing Address - Phone:978-835-8042
Mailing Address - Fax:603-880-3099
Practice Address - Street 1:113 CASTLE HILL RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1747
Practice Address - Country:US
Practice Address - Phone:978-835-8042
Practice Address - Fax:603-880-3099
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH94272085R0202X
MA730832085R0202X
CT675722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008393Medicaid
MA3143473Medicaid
MA3143473Medicaid
NHRE3981Medicare PIN
NH30008393Medicaid
NHRE3981Medicare PIN