Provider Demographics
NPI:1265435309
Name:CICCAGLIONE, ANTHONY G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:CICCAGLIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3715 MAIN ST
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000129874006OtherUNITED
CTZP085OtherOXFORD
CT129640OtherWELLCARE
CT4322371OtherAETNA
CT4394341002OtherCIGNA
CT001528OtherHEALTHNET
CT129640OtherFIRSTCHOICECT
CT2501583OtherGHI
CT739792OtherCONNECTICARE
CTB83664Medicare UPIN