Provider Demographics
NPI:1891900544
Name:CICCARONE, DANIEL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CICCARONE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DFCM, 500 PARNASSUS AVENUE
Mailing Address - Street 2:MU-3E, BOX 0900
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0900
Mailing Address - Country:US
Mailing Address - Phone:415-514-0275
Mailing Address - Fax:
Practice Address - Street 1:DFCM, 500 PARNASSUS AVENUE
Practice Address - Street 2:MU-3E, BOX 0900
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0900
Practice Address - Country:US
Practice Address - Phone:415-514-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF47708Medicare UPIN