Provider Demographics
NPI:1275508384
Name:LITCHMAN, MAUREEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:M
Last Name:LITCHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHARPE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3715
Mailing Address - Country:US
Mailing Address - Phone:570-552-8900
Mailing Address - Fax:570-552-8958
Practice Address - Street 1:2 SHARPE STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-552-8900
Practice Address - Fax:570-552-8958
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038417L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001001405Medicaid
PA001001405Medicaid
C29925Medicare UPIN