Healthcare Provider Details

I. General information

NPI: 1780617373
Provider Name (Legal Business Name): ABRAHAM LICHTMACHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE SUITE 301
ALBUQUERQUE NM
87109-1226
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE SUITE 301
ALBUQUERQUE NM
87109-1226
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-4500
  • Fax: 505-727-4505
Mailing address:
  • Phone: 505-727-4500
  • Fax: 505-727-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number138912
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2004-0673
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: