Provider Demographics
NPI:1750590097
Name:LICHTENBERGER, FRANK JOHN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:LICHTENBERGER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3517
Mailing Address - Country:US
Mailing Address - Phone:704-873-5055
Mailing Address - Fax:704-873-5025
Practice Address - Street 1:1525 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3517
Practice Address - Country:US
Practice Address - Phone:704-873-5055
Practice Address - Fax:704-873-5025
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00072207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4186144100Medicaid
NCNC5595A950OtherMEDICARE PTAN
NC1750590097Medicaid
BP1-0026150OtherINSTITUTIONAL PERMIT
SCNC2529Medicaid
NCNC5595BMedicare PIN
NCNC5595CMedicare PIN
BP1-0026150OtherINSTITUTIONAL PERMIT
NCNC5595A950OtherMEDICARE PTAN