MEDICARE: DR. ERIC DOUGLAS LICHTER M.D.

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	207V00000X	Obstetrics & Gynecology Physician	44065	MA

General Provider Information

NPI Number	:	1508826769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DOUGLAS LICHTER M.D.

Provider Business Mailing Address
First Line	:	1180 BEACON ST STE 6D
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-3806
Country	:	US
Telephone Number	:	617-879-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 BEACON ST STE 6D
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-3806
Country	:	US
Telephone Number	:	617-879-0393
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/03/2008

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