Organization
JACK R LICHTENSTEIN, MD LLC
Active
Parent organization
JACK R LICHTENSTEIN, MD LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACK R LICHTENSTEIN, MD LLC
Authorized official
MR. JACK R. LICHTENSTEIN M.D. (OWNER)
(410) 268-6910
Entity
Organization
Contact information
Practice address
205 RIDGELY AVE, ANNAPOLIS, MD 21401
(410) 263-6910
(443) 433-0456
Mailing address
205 RIDGELY AVE, ANNAPOLIS, MD 21401
(410) 263-6910
(443) 433-0456
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D08194
MD
207RR0500X
Rheumatology Physician
Primary
D0008194
MD
207RR0500X
Rheumatology Physician
D0065841
MD
207RR0500X
Rheumatology Physician
D08194
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3304001
CAREFIRST
MD
05
—
785361100
—
MD
01
—
J1740003
CAREFIRST
DC
Enumeration date
03/08/2006
Last updated
08/01/2008
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