Provider Demographics
NPI:1780677500
Name:PICCONE, CAROLYN A (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:PICCONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 BLAIR MILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1042
Mailing Address - Country:US
Mailing Address - Phone:215-443-0660
Mailing Address - Fax:215-443-8422
Practice Address - Street 1:2729 BLAIR MILL RD STE C
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1042
Practice Address - Country:US
Practice Address - Phone:215-443-0660
Practice Address - Fax:215-443-8422
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053443L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG31466Medicare UPIN
PA864795KB4Medicare ID - Type Unspecified