Provider Demographics
NPI:1073528725
Name:TUCHSEN, GEORGE RANDOLPH (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:RANDOLPH
Last Name:TUCHSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7690
Mailing Address - Country:US
Mailing Address - Phone:207-795-5767
Mailing Address - Fax:
Practice Address - Street 1:12 HIGH ST STE 401
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7690
Practice Address - Country:US
Practice Address - Phone:207-795-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24196208600000X
TXH8473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034978901Medicaid
F77981Medicare UPIN
TX00N25EMedicare PIN