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General NPI Number Information
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NPI Number | 1578700563
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Entity Type | Individual
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Provider Name | DEREK LICHTER FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 725 CONCORD AVE STE 4200
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City | CAMBRIDGE
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State | MA
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Zip | 02138-4680
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Country | US
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Telephone | 857-666-7337
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Fax | 617-864-0561
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Provider Business Mailing Address
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Address Line | 330 MT AUBURN ST PARSONS 2
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5597
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Country | US
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Telephone | 857-666-7337
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Fax | 617-864-0561
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN274591
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN274591
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License Number State | MA
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