Provider Demographics
NPI:1588819486
Name:LICHTMAN, RHONDA (PAC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 TREMONT ST APT G303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5078
Mailing Address - Country:US
Mailing Address - Phone:215-698-7626
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:66 W GILBERT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4947
Practice Address - Country:US
Practice Address - Phone:732-212-0060
Practice Address - Fax:732-212-0061
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001548L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical