Provider Demographics
NPI:1356338073
Name:VICCIONE, TODD (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:VICCIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 115
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-884-0333
Practice Address - Fax:401-884-0096
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2760-5OtherBCBS OF RI
RI12117948OtherMULTI PLAN
RI405285OtherBLUE CHIP
RI050483739OtherGREAT WESTERN HEALTH CARE
RI110196402OtherRAILROAD MEDICARE
RI694204OtherHARVARD HEALTH CARE
RI710037701OtherCIGNA
RI9002760Medicaid
RI04-02334OtherUNITED HEALTH CARE
RI4091OtherNEIGHBORHOOD HEALTH PLAN
RI709003943OtherMEDICARE GROUP
RI2282125OtherAETNA
RI404496OtherTUFTS HEALTH PLAN
RI405285OtherBLUE CHIP
RI405285OtherBLUE CHIP
RI007057262Medicare ID - Type Unspecified