Provider Demographics
NPI:1598855728
Name:LICHTER, ARLEN I (MD)
Entity Type:Individual
Prefix:
First Name:ARLEN
Middle Name:I
Last Name:LICHTER
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 1:1320 W MAIN ST
Mailing Address - Street 2:BLDG #2
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9355
Mailing Address - Fax:203-597-8192
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:BLDG #2
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9355
Practice Address - Fax:203-597-8192
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026437208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
0076757OtherAETNA US HEALTH CARE
010026437CT01OtherANTHEM BCBS OF CT
706580OtherCONNECTICARE
7401415003OtherCIGNA
ORO322OtherHEALTH NET
NHS075OtherOXFORD
706580OtherCONNECTICARE