Provider Demographics
NPI:1164620548
Name:LICHT, RASHMI S (MD)
Entity Type:Individual
Prefix:
First Name:RASHMI
Middle Name:S
Last Name:LICHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RASHMI
Other - Middle Name:
Other - Last Name:SHETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BUILDING 14
Mailing Address - City:E PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-435-6600
Mailing Address - Fax:
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BUILDING 14
Practice Address - City:E PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-435-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12433208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI349005986OtherMEDICARE GROUP PTAN
RI33036OtherBLUE SHIELD
RIRL67411Medicaid
RIMD12433OtherMEDICAL LICENSE
RI33036OtherBLUE SHIELD