Healthcare Provider Details

I. General information

NPI: 1982920336
Provider Name (Legal Business Name): LISA JANE HANNAH CICHON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA JANE HANNAH STONEHOCKER

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 NC HIGHWAY 751 APT 1109
DURHAM NC
27707-5720
US

IV. Provider business mailing address

7250 NC HIGHWAY 751 APT 1109
DURHAM NC
27707-5720
US

V. Phone/Fax

Practice location:
  • Phone: 773-934-4853
  • Fax:
Mailing address:
  • Phone: 773-934-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number074043
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: