Provider Demographics
NPI:1619966926
Name:LITSCHER, LARRY A (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:LITSCHER
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 1:382 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:E LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1828
Mailing Address - Country:US
Mailing Address - Phone:413-525-8601
Mailing Address - Fax:413-525-8604
Practice Address - Street 1:382 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:E LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1828
Practice Address - Country:US
Practice Address - Phone:413-525-8601
Practice Address - Fax:413-525-8604
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54086207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0002295OtherGROUP PTAN
MA110047857AMedicaid
1053503912OtherGROUP NPI
MA1619966926OtherNPI
S400180318OtherACTIVE PROVIDER TRANSACTION ACCESS NUMBER
MA110047857AMedicaid