MEDICARE: DR. RICHARD A LICHTENBERG 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	207RC0000X	Cardiovascular Disease Physician	MD018781E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CF6196	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	131926	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0031373000	OTHER	PA	KEYSTONE
4	58229	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1861496705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A LICHTENBERG M.D.

Provider Business Mailing Address
First Line	:	1999 SPROUL RD
Second Line	:	STE 21
City	:	BROOMALL
State	:	PA
Zip	:	19008-3508
Country	:	US
Telephone Number	:	610-353-6400
Fax Number	:	610-356-1204

Provider Business Practice Location Address
First Line	:	1999 SPROUL RD
Second Line	:	STE 21
City	:	BROOMALL
State	:	PA
Zip	:	19008-3508
Country	:	US
Telephone Number	:	610-353-6400
Fax Number	:	610-356-1204

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	01/23/2008

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Directions to “ DR. RICHARD A LICHTENBERG M.D.” Practice Location

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