Provider Demographics
NPI:1871671198
Name:LICHTER-KONECKI, UTA (MD)
Entity Type:Individual
Prefix:
First Name:UTA
Middle Name:
Last Name:LICHTER-KONECKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 PENN AVE
Mailing Address - Street 2:FACULTY PAVILION, SUITE 1200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224
Mailing Address - Country:US
Mailing Address - Phone:412-692-5070
Mailing Address - Fax:412-692-6472
Practice Address - Street 1:1 CHILDRENS HOSPITAL DR
Practice Address - Street 2:4401 PENN AVENUE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1529
Practice Address - Country:US
Practice Address - Phone:412-692-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD34366207SG0201X
PAMD455276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103028410Medicaid
PA103028410Medicaid