Individual
PETER RIBACK LICHSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22771
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1277M
BCBS
NC
01
—
36909
PARTNERS
NC
05
—
3810000703
—
WV
01
—
5584041
AETNA
—
05
—
5865948
—
VA
05
—
891277M
—
NC
01
—
A2506
MEDCOST
NC
05
—
Q22771
—
SC
Enumeration date
11/18/2005
Last updated
05/13/2008
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