Healthcare Provider Details

I. General information

NPI: 1871586180
Provider Name (Legal Business Name): JASON BRETT LICHTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 N COLUMBUS ST STE A
LANCASTER OH
43130-8991
US

IV. Provider business mailing address

2656 N COLUMBUS ST STE A
LANCASTER OH
43130-8991
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-5064
  • Fax: 740-653-6474
Mailing address:
  • Phone: 740-653-5064
  • Fax: 740-653-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35084162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: