Provider Demographics
NPI:1184721383
Name:ANTHONY CICCAGLIONE, MD PC
Entity type:Organization
Organization Name:ANTHONY CICCAGLIONE, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CICCAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-371-0406
Mailing Address - Street 1:3715 MAIN ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3611
Mailing Address - Country:US
Mailing Address - Phone:203-371-0406
Mailing Address - Fax:203-371-6206
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3611
Practice Address - Country:US
Practice Address - Phone:203-371-0406
Practice Address - Fax:203-371-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001528OtherHEALTHNET
CT047428001OtherCOMMUNITY HEALTH NETWORK
CTCIGNAOther4394341002
CTZP085OtherOXFORD
CT000129874006OtherAARP
CT010027876CT03OtherBLUE CROSS AND SHIELD
CT110058972OtherRETIRED RAILROAD MEDICARE
CT129640OtherFIRSTCHOICE
CT001278761Medicaid
CT2501583OtherGHI
CT000129874006OtherUNITED HEALTHCARE
CT010027876CT02OtherBLUE CROSS AND BLUE SHIEL
CT129640OtherWELLCARE
CT047428001OtherTRICARE
CT739792OtherCONNECTICARE
CT4322371OtherAETNA
CT129640OtherWELLCARE
CT739792OtherCONNECTICARE
CT739792OtherCONNECTICARE
CT11003945Medicare PIN
CT2501583OtherGHI