Provider Demographics
NPI:1447341243
Name:LITCHMAN, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:LITCHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST AVENUE
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-838-4034
Mailing Address - Fax:203-853-6361
Practice Address - Street 1:148 EAST AVENUE
Practice Address - Street 2:SUITE 3G
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-4034
Practice Address - Fax:203-853-6361
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027828207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001278284Medicaid
E39126Medicare UPIN
CT001278284Medicaid