Individual
MR. JACK R LICHTENSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 RIDGELY AVE, ANNAPOLIS, MD 21401
(410) 263-6910
(443) 443-0456
Mailing address
205 RIDGELY AVE, ANNAPOLIS, MD 21401
(410) 263-6910
(443) 443-0456
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D08194
MD
207RR0500X
Rheumatology Physician
D08194
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3304001
CAREFIRST
MD
01
—
J1740003
CAREFIRST
DC
Enumeration date
03/09/2006
Last updated
02/21/2008
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