Provider Demographics
NPI:1417078833
Name:LITHMAN, JERRY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RICHARD
Last Name:LITHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1515 WEST NC HIGHWAY 54
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5576
Mailing Address - Country:US
Mailing Address - Phone:919-490-8009
Mailing Address - Fax:919-403-9029
Practice Address - Street 1:1515 WEST NC HIGHWAY 54
Practice Address - Street 2:SUITE 210
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5576
Practice Address - Country:US
Practice Address - Phone:919-490-8009
Practice Address - Fax:919-403-9029
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC330842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
208271DMedicare ID - Type Unspecified
C81466Medicare UPIN