Provider Demographics
NPI:1982726055
Name:NICEFORO, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:NICEFORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3250
Mailing Address - Fax:
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110036158AMedicaid
MA1982726055OtherEVERCARE
MA1982726055OtherANTHEM
AA148082OtherHARVARD PILGRIM HEALTHCARE
MA1982726055OtherAETNA
MA1982726055OtherBCBS
NH30200155Medicaid
MA710420OtherTUFTS
MA1982726055OtherFALLON COMMUNITY HEALTH PLAN
MA6130738OtherCIGNA
MA0046247OtherNEIGHBORHOOD HEALTH PLAN
MA4346215OtherAETNA NON HMO
MA94634001OtherNETWORK HEALTH
MA110036158AMedicaid