Provider Demographics
NPI:1790747970
Name:MONTICCIOLO, RICHARD (MD)
Entity Type:Individual
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First Name:RICHARD
Middle Name:
Last Name:MONTICCIOLO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2275 SILAS DEANE HWY
Mailing Address - Street 2:RICHARD MONTICCIOLO MD AND MARIE MONTICCIOLO MD, LLP
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:860-257-7405
Mailing Address - Fax:860-257-8788
Practice Address - Street 1:2275 SILAS DEANE HWY
Practice Address - Street 2:RICHARD MONTICCIOLO MD AND MARIE MONTICCIOLO MD, LLP
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-257-7405
Practice Address - Fax:860-257-8788
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-03-12
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Provider Licenses
StateLicense IDTaxonomies
CT028760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1287607Medicaid
CT1287607Medicaid
B83395Medicare UPIN