Provider Demographics
NPI:1447260096
Name:KORTHAMAR, BARBARA LICHT (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LICHT
Last Name:KORTHAMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 SCOTT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4500
Mailing Address - Country:US
Mailing Address - Phone:408-248-2035
Mailing Address - Fax:408-244-7853
Practice Address - Street 1:1280 SCOTT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4500
Practice Address - Country:US
Practice Address - Phone:408-248-2035
Practice Address - Fax:408-244-7853
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30788208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03078800Medicaid