MEDICARE: DR. THOMAS O. WILLCOX M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	MD-042070-E	PA
2	207Y00000X	Otolaryngology Physician	MD-042070-E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093735789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS O. WILLCOX M.D.

Provider Business Mailing Address
First Line	:	925 CHESTNUT STREET
Second Line	:	6TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4204
Country	:	US
Telephone Number	:	215-955-6760
Fax Number	:	215-923-4532

Provider Business Practice Location Address
First Line	:	925 CHESTNUT ST
Second Line	:	6TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4204
Country	:	US
Telephone Number	:	215-955-6760
Fax Number	:	215-923-4532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	06/11/2020

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