Provider Demographics
NPI:1043241276
Name:LICHTER, STEPHEN MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARC
Last Name:LICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3518
Mailing Address - Country:US
Mailing Address - Phone:718-616-0801
Mailing Address - Fax:718-616-0809
Practice Address - Street 1:2558 E 18TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3518
Practice Address - Country:US
Practice Address - Phone:718-616-0801
Practice Address - Fax:718-616-0809
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127425207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B11351Medicare UPIN