Individual
JORDAN JOSEPH LICHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 E PARK AVE, STATE COLLEGE, PA 16803-6709
(814) 231-7000
Mailing address
PO BOX 16, STATE COLLEGE, PA 16804-0016
(814) 466-5090
(814) 466-5095
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD452089
PA
207R00000X
Internal Medicine Physician
MT197760
PA
Other
Enumeration date
09/28/2010
Last updated
03/08/2015
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