Provider Demographics
NPI:1750378824
Name:CICCONE, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CICCONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2454
Practice Address - Street 1:3510 HWY 17 NORTH
Practice Address - Street 2:STE 325
Practice Address - City:MT. PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8232
Practice Address - Country:US
Practice Address - Phone:843-606-8982
Practice Address - Fax:843-606-8077
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA37832207RC0000X
SC34588207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K9389OtherHEALTHNET
ES226OtherOXFORD
0963382002OtherCIGNA
1075758OtherHORIZON MERCY
NJ1747304Medicaid
4094234OtherAETNA
81554OtherAMERIGROUP
010000347500OtherAMERICHOICE
0199893000OtherAMERIHEALTH
5710570OtherGHI
28F431OtherWELLCHOICE
1K9389OtherHEALTHNET
81554OtherAMERIGROUP