Healthcare Provider Details

I. General information

NPI: 1164788550
Provider Name (Legal Business Name): ANN HALEY LICHTENSTEIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 PICCARD DR STE 100
ROCKVILLE MD
20850-4317
US

IV. Provider business mailing address

1355 PICCARD DR STE 100
ROCKVILLE MD
20850-4317
US

V. Phone/Fax

Practice location:
  • Phone: 301-921-4400
  • Fax: 301-921-4433
Mailing address:
  • Phone: 301-921-4400
  • Fax: 301-921-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberHE3300
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: