Provider Demographics
NPI:1922016831
Name:LICHTIG, LISA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:LICHTIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:HANAWAY
Other - Last Name:LICHTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:207 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801
Mailing Address - Country:US
Mailing Address - Phone:828-251-2700
Mailing Address - Fax:828-251-2725
Practice Address - Street 1:207 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-251-2700
Practice Address - Fax:828-251-2725
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891222EMedicaid
NC1222EOtherBCBS
NC1222EOtherBCBS
F02239Medicare UPIN