Healthcare Provider Details

I. General information

NPI: 1083722409
Provider Name (Legal Business Name): LAWRENCE J LITSCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MIAMI VALLEY DR SUITE 500
CENTERVILLE OH
45459-4778
US

IV. Provider business mailing address

6680 POE AVE SUITE 200
DAYTON OH
45414-2854
US

V. Phone/Fax

Practice location:
  • Phone: 937-425-0003
  • Fax: 937-425-0004
Mailing address:
  • Phone: 937-280-8400
  • Fax: 937-280-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35053420
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberOH053420
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: