Provider Demographics
NPI:1780677997
Name:OALICAN, RODISENDO P (MD)
Entity type:Individual
Prefix:DR
First Name:RODISENDO
Middle Name:P
Last Name:OALICAN
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 1:144 COHANNET ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3908
Mailing Address - Country:US
Mailing Address - Phone:508-824-8639
Mailing Address - Fax:508-880-7648
Practice Address - Street 1:144 COHANNET ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3908
Practice Address - Country:US
Practice Address - Phone:508-824-8639
Practice Address - Fax:508-880-7648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2005875Medicaid
MA2005875Medicaid
MAA59711Medicare UPIN