Provider Demographics
NPI:1306871934
Name:MALCOLM C. LOCHIEL, MD, PA
Entity type:Organization
Organization Name:MALCOLM C. LOCHIEL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCHIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-251-7273
Mailing Address - Street 1:5008 WEDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2834
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:601 MEDICAL PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5412
Practice Address - Country:US
Practice Address - Phone:979-251-7273
Practice Address - Fax:979-251-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163754801Medicaid
TX00460VMedicare PIN