Individual
DR. DOUGLAS L JICHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
306 US ROUTE 1, BLDG C, SCARBOROUGH, ME 04074
(207) 885-5742
(207) 885-1494
Mailing address
306 US ROUTE 1, BLDG C, SCARBOROUGH, ME 04074
(207) 885-5742
(207) 885-1494
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
006810
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132540000
—
ME
Enumeration date
07/10/2006
Last updated
11/03/2021
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