Provider Demographics
NPI:1134102601
Name:LICHAUCO, TOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:F
Last Name:LICHAUCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:198 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3563
Mailing Address - Country:US
Mailing Address - Phone:781-329-7311
Mailing Address - Fax:781-461-9224
Practice Address - Street 1:333 ELM ST
Practice Address - Street 2:FAMILY PHYSICIANS OF DEDHAM WESTWOOD
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4530
Practice Address - Country:US
Practice Address - Phone:781-329-7311
Practice Address - Fax:781-461-9224
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA76159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22043Medicare UPIN
MAA222399Medicare ID - Type Unspecified