Provider Demographics
NPI:1205844487
Name:BERNARD J. LICHTENSTEIN, MD, APC
Entity Type:Organization
Organization Name:BERNARD J. LICHTENSTEIN, MD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICHTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-467-0500
Mailing Address - Street 1:7930 FROST ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2737
Mailing Address - Country:US
Mailing Address - Phone:858-467-0500
Mailing Address - Fax:866-716-9201
Practice Address - Street 1:7930 FROST ST
Practice Address - Street 2:SUITE103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2737
Practice Address - Country:US
Practice Address - Phone:858-467-0500
Practice Address - Fax:866-716-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11114Medicare ID - Type UnspecifiedINTERNAL MEDICINE GROUP