Individual
DR. ROBERT LICHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-7237
(774) 441-8443
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
72925
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110048901A
—
MA
05
—
3067866
—
MA
Enumeration date
06/05/2006
Last updated
06/07/2021
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