Provider Demographics
NPI:1457491573
Name:LICHTMAN, ALLAN SIDNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:SIDNEY
Last Name:LICHTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTHSTAR ST PH 1
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6731
Mailing Address - Country:US
Mailing Address - Phone:310-301-0909
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHSTAR ST PH 1
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6731
Practice Address - Country:US
Practice Address - Phone:310-301-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-19231207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology