Jack R Lichtenstein, MD LLC

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

D0008194 Issued in MD

Legal business name

JACK R LICHTENSTEIN, MD LLC

Practice address

205 Ridgely Ave
Annapolis, MD 21401

Phone

(410) 263-6910

Fax

(443) 433-0456

NPI assigned

Mar 8, 2006

Organization subpart

Yes

Parent organization

JACK R LICHTENSTEIN, MD LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jack R. Lichtenstein, M.D.

Title

Owner

Phone

(410) 268-6910

Specialties & licenses 4

Addresses

Other identifiers 3

Part of

Jack R Lichtenstein MD LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1043288087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 RIDGELY AVE",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "21401",
            "telephone_number": "410-263-6910",
            "fax_number": "443-433-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 RIDGELY AVE",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "21401",
            "telephone_number": "410-263-6910",
            "fax_number": "443-433-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK R LICHTENSTEIN, MD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACK R LICHTENSTEIN, MD LLC",
        "enumeration_date": "2006-03-08",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "LICHTENSTEIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-268-6910",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D08194",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MD",
            "license": "D08194",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MD",
            "license": "D0008194",
            "primary": true
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MD",
            "license": "D0065841",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "3304001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "J1740003",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "785361100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adeeb Jaber, MD
• Samantha Louise Jackson-Dilts, M.D.
• A'Neishia Jackson
• John D Jackson, MD
• Kai Love Jackson, BT, RPHT
• Kendra Lorraine Jackson, LPC

• Rheumatology Physician in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Rheumatology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.