MEDICARE: DARYL D. DICHOSO, M.D., P.A.

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	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1942590633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARYL D. DICHOSO, M.D., P.A.

Provider Business Mailing Address
First Line	:	3733 WESTHEIMER RD STE 1
Second Line	:	PMB #781
City	:	HOUSTON
State	:	TX
Zip	:	77027-5226
Country	:	US
Telephone Number	:	281-252-9993
Fax Number	:	800-376-2814

Provider Business Practice Location Address
First Line	:	3733 WESTHEIMER RD STE 1
Second Line	:	PMB #781
City	:	HOUSTON
State	:	TX
Zip	:	77027-5226
Country	:	US
Telephone Number	:	888-897-2724
Fax Number	:	800-376-2814

Authorized Official
Title or Position	:	PROVIDER
Name	:	DARYL D DICHOSO
Credential	:	M.D.
Telephone Number	:	888-897-2724

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	01/20/2012

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