Individual
DR. LUIS TICONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 MASSACHUSETTS AVE, CROSSTOWN 6B, BOSTON, MA 02118-2605
(617) 414-5951
(617) 414-9201
Mailing address
761 WORCESTER RD, FRAMINGHAM, MA 01701-5224
(508) 872-3254
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
251665
MA
207R00000X
Internal Medicine Physician
Primary
262882
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110104119A
—
MA
Enumeration date
06/14/2012
Last updated
11/24/2019
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