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General NPI Number Information
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NPI Number | 1609844224
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Entity Type | Individual
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Provider Name | JACK R LICHTENSTEIN MD
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 205 RIDGELY AVE
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City | ANNAPOLIS
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State | MD
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Zip | 21401
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Country | US
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Telephone | 410-263-6910
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Fax | 443-443-0456
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Provider Business Mailing Address
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Address Line | 205 RIDGELY AVE
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City | ANNAPOLIS
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State | MD
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Zip | 21401
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Country | US
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Telephone | 410-263-6910
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Fax | 443-443-0456
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D08194
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | D08194
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License Number State | MD
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