MEDICARE: JANE E LIEDTKA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD000020331	DC

General Provider Information

NPI Number	:	1215098942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE E LIEDTKA MD

Provider Business Mailing Address
First Line	:	4420 BURLINGTON PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4422
Country	:	US
Telephone Number	:	202-641-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 BURLINGTON PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4422
Country	:	US
Telephone Number	:	202-641-1106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/29/2016

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