MEDICARE: DR. CHARISSE D LITCHMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	032332	CT

General Provider Information

NPI Number	:	1487650693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARISSE D LITCHMAN MD

Provider Business Mailing Address
First Line	:	1290 SUMMER ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5360
Country	:	US
Telephone Number	:	203-969-7662
Fax Number	:	203-969-0809

Provider Business Practice Location Address
First Line	:	1290 SUMMER ST
Second Line	:	5200
City	:	STAMFORD
State	:	CT
Zip	:	06905-5360
Country	:	US
Telephone Number	:	203-969-7662
Fax Number	:	203-969-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/30/2012

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