1659391738 NPI number — DR. ALAN LICHTENSTEIN M.D.

Table of content: DR. ALAN LICHTENSTEIN M.D. (NPI 1659391738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659391738 NPI number — DR. ALAN LICHTENSTEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LICHTENSTEIN
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659391738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9411 SILVERTHORN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33777-3166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-424-2660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 6TH ST S
Provider Second Line Business Practice Location Address:
BAYFRONT HEALTH DEPT OF ANESTHESIA
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-424-2660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME0072247 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32954 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00680591 . This is a "RAILROAD MCR ATTACHED TO GRP CF4811" identifier . This identifiers is of the category "OTHER".
  • Identifier: ME0072247 . This is a "FL MEDICAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261615700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".