Provider Demographics
NPI:1710995410
Name:CECCHETTI, CARLO (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:CECCHETTI
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 1:5 THAXTON RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1550
Mailing Address - Country:US
Mailing Address - Phone:781-724-3452
Mailing Address - Fax:
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-665-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2051591Medicaid
MAB31106Medicare ID - Type Unspecified
MA2051591Medicaid