Provider Demographics
NPI:1023092483
Name:PICCOLELLO, MARCELLE L (MD)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:L
Last Name:PICCOLELLO
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 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI86212085R0202X
RIMD086212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
008621OtherBLUE SHIELD
008621OtherTUFTS
3202330OtherMASSMEDICAID
004953OtherBLUE CHIP
07003962OtherHOSPITAL PIN
300067429OtherRAILROAD MEDICARE
3202330OtherHEALTHYSTART
720051601OtherCIGNA
000000001988OtherNHPRI
003111523OtherCT MED ASSISTANCE
1600203OtherUNITED HEALTH PLANS
240155OtherW & I PILGRIM
7003962OtherRIMEDICALASSISTANCE
240155OtherRIHPILGRIM