Provider Demographics
NPI:1295363091
Name:WICKHAM, THOMAS ROBERT (DO, MPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:WICKHAM
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Gender:M
Credentials:DO, MPH
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Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:155 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5140
Practice Address - Country:US
Practice Address - Phone:978-345-1919
Practice Address - Fax:978-342-6240
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2023-10-11
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Provider Licenses
StateLicense IDTaxonomies
MA1014436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine