Provider Demographics
NPI:1659448058
Name:LICHTER, BARRY I (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:I
Last Name:LICHTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24963
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0963
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:
Practice Address - Street 1:500 17TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5711
Practice Address - Country:US
Practice Address - Phone:206-320-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO000000165213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0180986OtherLABOR AND INDUSTRIES
WA1109669Medicaid
WA1109669Medicaid
T01692Medicare UPIN