Provider Demographics
NPI:1730318791
Name:PICCHIONE, MARK P (IDMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:PICCHIONE
Suffix:
Gender:M
Credentials:IDMT
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Other - Credentials:
Mailing Address - Street 1:310 WORCHESTER AVE
Mailing Address - Street 2:BLDG 45
Mailing Address - City:HICKAM AFB
Mailing Address - State:HI
Mailing Address - Zip Code:96853-5530
Mailing Address - Country:US
Mailing Address - Phone:808-474-4960
Mailing Address - Fax:808-474-4880
Practice Address - Street 1:310 WORCHESTER AVE
Practice Address - Street 2:BLDG 45
Practice Address - City:HICKAM AFB
Practice Address - State:HI
Practice Address - Zip Code:96853-5530
Practice Address - Country:US
Practice Address - Phone:808-474-4960
Practice Address - Fax:808-474-4880
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians