| Jack R Lichtenstein, Md Llc | |
|
205 Ridgely Ave Annapolis MD 21401 | |
| (410) 263-6910 | |
| (443) 433-0456 |
| Full Name | Jack R Lichtenstein, Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 205 Ridgely Ave, Annapolis, Maryland |
| Authorized Official Name and Position | Jack R. Lichtenstein (OWNER) |
| Authorized Official Contact | 4102686910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack R Lichtenstein, Md Llc 205 Ridgely Ave Annapolis MD 21401 Ph: (410) 263-6910 | Jack R Lichtenstein, Md Llc 205 Ridgely Ave Annapolis MD 21401 Ph: (410) 263-6910 |
| NPI Number | 1043288087 |
|---|---|
| Provider Enumeration Date | 03/08/2006 |
| Last Update Date | 08/01/2008 |
| Medicare PECOS PAC ID | 4880680081 |
|---|---|
| Medicare Enrollment ID | O20040422001374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043288087 | NPI | - | NPPES |
| 3304001 | Other | MD | CAREFIRST |
| J1740003 | Other | DC | CAREFIRST |
| 785361100 | Medicaid | MD |
| Provider Name | Jack R Lichtenstein |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1609844224 PECOS PAC ID: 0941294359 Enrollment ID: I20040409000078 |
| Provider Name | Tamiko A Bryant |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154385912 PECOS PAC ID: 8729043526 Enrollment ID: I20061004000373 |
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