Individual
DR. JACK HOWARD LICHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
VETERANS AFFAIRS MEDICAL CTR, 50 IRVING ST NW, WASHINGTON, DC 20422-0001
(202) 745-8285
(202) 745-8284
Mailing address
11603 MONTICELLO AVE, SILVER SPRING, MD 20902-1709
(202) 745-8285
(202) 745-8284
Taxonomy
Speciality
Code
Description
License number
State
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
MD034930E
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD034930E
PA
Other
Enumeration date
09/29/2006
Last updated
09/18/2015
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