Provider Demographics
NPI:1982981536
Name:JOSEPH M LICHTMAN, MD PC
Entity Type:Organization
Organization Name:JOSEPH M LICHTMAN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-922-4274
Mailing Address - Street 1:514 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1593
Mailing Address - Country:US
Mailing Address - Phone:215-922-4274
Mailing Address - Fax:215-922-2715
Practice Address - Street 1:514 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1593
Practice Address - Country:US
Practice Address - Phone:215-922-4274
Practice Address - Fax:215-922-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033646L305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31358Medicare UPIN