Provider Demographics
NPI:1871586180
Name:LICHTEN, JASON BRETT (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:BRETT
Last Name:LICHTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2656 N COLUMBUS ST STE A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8991
Mailing Address - Country:US
Mailing Address - Phone:740-653-5064
Mailing Address - Fax:740-653-6474
Practice Address - Street 1:2656 N COLUMBUS ST STE A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8991
Practice Address - Country:US
Practice Address - Phone:740-653-5064
Practice Address - Fax:740-653-6474
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35084162208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery