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General NPI Number Information
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NPI Number | 1922213388
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Entity Type | Organization
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Legal Business Name | GARY D LICHTEN MD INC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 157 W CEDAR ST STE. 201
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City | AKRON
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State | OH
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Zip | 44307-2564
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Country | US
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Telephone | 330-253-7164
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Fax | 330-434-3376
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Provider Business Mailing Address
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Address Line | 157 W CEDAR ST STE. 201
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City | AKRON
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State | OH
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Zip | 44307-2564
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Country | US
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Telephone | 330-253-7164
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Fax | 330-434-3376
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY D LICHTEN
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Credential | MD
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Telephone | 330-253-7164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35038945
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License Number State | OH
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