Individual
DR. GARY D LICHTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3624 W MARKET ST, FAIRLAWN, OH 44333-4510
(330) 665-0555
(330) 665-0556
Mailing address
3624 W MARKET ST, FAIRLAWN, OH 44333-4510
(330) 665-0555
(330) 665-0556
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35038945
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0368963
—
OH
Enumeration date
09/08/2005
Last updated
07/25/2016
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