Provider Demographics
NPI:1821026055
Name:LICHAUCO, MACARIO F (MD)
Entity Type:Individual
Prefix:DR
First Name:MACARIO
Middle Name:F
Last Name:LICHAUCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:489 STATE ST
Mailing Address - Street 2:KELLY 6 EASTERN MAINE MEDICAL CENTER
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6616
Mailing Address - Country:US
Mailing Address - Phone:207-973-8670
Mailing Address - Fax:207-973-5163
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:KELLY 6 EASTERN MAINE MEDICAL CENTER
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-8670
Practice Address - Fax:207-973-5163
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35149711208000000X, 208M00000X
ME0155082080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0033779Medicaid
MEMM9116Medicare ID - Type Unspecified