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NPI Code Detail

MEDICARE: ALEX LICHTENAUER

MEDICARE: ALEX LICHTENAUER
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
1246Z00000XOther Specialist/TechnologistAK001328PA

General Provider Information

NPI Number : 1710630660
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEX LICHTENAUER
Provider Business Mailing Address
First Line : 2018 MOUNTAIN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-1428
Country : US
Telephone Number : 443-632-4381
Fax Number :
Provider Business Practice Location Address
First Line : 2308 GRAYS FERRY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19146-1177
Country : US
Telephone Number : 215-772-1040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2022
Last Update Date : 02/01/2022

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Directions to “ ALEX LICHTENAUER ” Practice Location

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