Basic Information
| Provider Information | |||||||||
| NPI: | 1750590097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LICHTENBERGER | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2372 | ||||||||
| Address2: | |||||||||
| City: | SKYLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287762372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283502163 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 DAVIE AVE | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286773517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048735055 | ||||||||
| FaxNumber: | 7048735025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 2012-00072 | NC | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | BP1-0026150 | 01 | INSTITUTIONAL PERMIT | OTHER | NC2529 | 05 | SC | MEDICAID | 1750590097 | 05 | NC | MEDICAID | 4186144100 | 05 | MD | MEDICAID | NC5595A950 | 01 | NC | MEDICARE PTAN | OTHER |