Healthcare Provider Details

I. General information

NPI: 1215098504
Provider Name (Legal Business Name): JOHN LICHTENBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GW MEDICAL FACULTY ASSOCIATES, INC 900 23RD ST NW
WASHINGTON DC
20037
US

IV. Provider business mailing address

900 23RD ST NW OFC G-113
WASHINGTON DC
20037-2342
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-5189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number243064
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA119028
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD046109
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: