Provider Demographics
NPI:1902803430
Name:MARCIELLO, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MARCIELLO
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 1:14 ASYLUM ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2203
Mailing Address - Country:US
Mailing Address - Phone:508-473-5500
Mailing Address - Fax:508-478-6247
Practice Address - Street 1:14 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2203
Practice Address - Country:US
Practice Address - Phone:508-473-5500
Practice Address - Fax:508-478-6247
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152314208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
J18237OtherBLUE SHIELD INDEMNITY
MA1330093OtherHEALTHSOURCE
37981OtherHARVARD PILGRIM PPO
152314OtherTUFTS
152314OtherTUFTS TOTAL HEALTH PLAN
27559OtherCHILDREN'S MED. SECURITY
37981OtherHARVARD PILGRIM POS
J18237OtherHMO BLUE/BLUE CHOICE
1330093OtherCIGNA HEALTH CARE
152314OtherTUFTS BENEFIT ADMIN.
152314OtherTUFTS COMMONWEALTH PPO
3177785OtherMASS.HEALTH(DIV.MEDSVCS)
37981OtherHARVARD PILGRIM
G66678OtherFIRST SENIORITY
J18237OtherBS-BLUE CARE ELECT
0013250OtherNEIGHBORHOOD HEALTH PLAN
23-00079OtherUNITED HEALTHCARE(HMO/PPO
250010159OtherRAILROAD MEDICARE
37981OtherHARVARD PILGRIM POS
G66678OtherFIRST SENIORITY