Healthcare Provider Details

I. General information

NPI: 1255321600
Provider Name (Legal Business Name): GARY B LICHTENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COMMERCE RD 413
STAUNTON VA
24401-4433
US

IV. Provider business mailing address

401 COMMERCE RD 413
STAUNTON VA
24401-4433
US

V. Phone/Fax

Practice location:
  • Phone: 540-886-0988
  • Fax: 540-886-3833
Mailing address:
  • Phone: 540-886-0988
  • Fax: 540-886-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101032464
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: