MEDICARE: DR. TATIANA DICOBY D.O.

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	207V00000X	Obstetrics & Gynecology Physician	251119	NY
2	207V00000X	Obstetrics & Gynecology Physician	DO.OP.61684184	WA

General Provider Information

NPI Number	:	1114164696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATIANA DICOBY D.O.

Provider Business Mailing Address
First Line	:	1608 S J ST FL 1
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4930
Country	:	US
Telephone Number	:	253-274-7501
Fax Number	:	253-274-7991

Provider Business Practice Location Address
First Line	:	1608 S J ST FL 1
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4930
Country	:	US
Telephone Number	:	253-274-7501
Fax Number	:	253-274-7991

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

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	05/28/2026

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