MEDICARE: DR. TOMAS F LICHAUCO 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	207Q00000X	Family Medicine Physician	76159	MA

General Provider Information

NPI Number	:	1134102601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMAS F LICHAUCO M.D.

Provider Business Mailing Address
First Line	:	198 WASHINGTON ST
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-3563
Country	:	US
Telephone Number	:	781-329-7311
Fax Number	:	781-461-9224

Provider Business Practice Location Address
First Line	:	333 ELM ST
Second Line	:	FAMILY PHYSICIANS OF DEDHAM WESTWOOD
City	:	DEDHAM
State	:	MA
Zip	:	02026-4530
Country	:	US
Telephone Number	:	781-329-7311
Fax Number	:	781-461-9224

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	08/09/2011

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