DR. PETER DOUGLASS LICHTY (NPI# 1548480122) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548480122 |
| Entity Type | Individual |
| Full Name | DR. PETER DOUGLASS LICHTY |
| Credential | MD MOH |
| Practice Address |
1 Cyclotron Rd Mailstop 26r0143 Berkeley CA 94720-8239 |
| Practice Telephone | 5104866267 |
| Mailing Telephone | 5104866267 |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
G055368 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
1 CYCLOTRON RD MAILSTOP 26R0143 |
| City | BERKELEY |
| State | CA |
| Zip Code | 94720-8239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154708956 | Susan Broadway | Nurse Practitioner | 1 Cyclotron Rd, Ms26r0143, Berkeley, CA 94720-8099 | 2015-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609352798 | Richard Phan | Optometrist | 200 Minor Ln, Berkeley, CA 94720 | 2018-07-12 |
| 1184082067 | Carmen Lee | Registered Nurse | 2222 Bancroft Way, Mc4300, Berkeley, CA 94720 | 2016-02-05 |
| 1922355148 | Cynthia Medina | Counselor | 2222 Bancroft Way #4300, Berkeley, CA 94720 | 2012-08-07 |
| 1811199615 | Ellen De Neef | Physical Therapist | 2222 Bancroft, Berkeley, CA 94720 | 2007-06-04 |
| 1427185529 | Margaret Anne Fisher | Nurse Practitioner | 2222 Bancroft Ave, Berkeley, CA 94720 | 2007-02-27 |
| 1619049285 | Vikki V. Yu | Optometrist | 230 Minor Hall, Uc Berkeley School of Optometry, Berkeley, CA 94720 | 2006-11-15 |
| 1801992755 | Robert K Osborne Dds & Assoc Inc | Dentist | 1177 South Main St, North Canton, OH 94720 | 2006-09-16 |
| 1154949899 | Thuy-trang Nguyen | Optometrist | 230 Minor Hall, Berkeley, CA 94720 | 2020-07-09 |
| 1619498656 | Celia R Gong | Optometrist | 230 Minor Hall, Berkeley, CA 94720 | 2017-06-29 |
| 1790234680 | Kelsey Lindquist | Specialist/Technologist | 185 Haas Pavilion, Berkeley, CA 94720 | 2016-10-03 |
| Find all providers in zip 94720 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558499079 | Robert Wagner | Preventive Medicine | 2850 7th St Ste 100, Berkeley, CA 94710-2703 | 2007-02-28 |
| 1952459240 | Diane Liu | Preventive Medicine | 2222 Bancroft Ext, Berkeley, CA 94720-4300 | 2007-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750911665 | Healthstat Wellness Sutter County | Preventive Medicine | 1215 Plumas St Ste 1300a, Yuba City, CA 95991-3400 | 2020-01-20 |
| 1194373530 | Healthstat Wellness County of Santa Barbara Headquarters | Preventive Medicine | 427 Camino Del Remedio Bldg G, Santa Barbara, CA 93110-1310 | 2019-08-29 |
| 1023678661 | Linda K Watanabe | Preventive Medicine | 700 Bay Rd. #2803, Redwood City, CA 94063 | 2019-06-17 |
| 1750872255 | Universal Occupational Medicine PC | Preventive Medicine | 8303 Brimhall Rd Bldg 1500, Bakersfield, CA 93312-2243 | 2018-05-21 |
| 1831694272 | Healthstat Wellness County Sb Headquarters | Preventive Medicine | 2500 Broadway Ste 400, Santa Monica, CA 90404-3176 | 2018-03-28 |
| 1326548363 | Paul Manchester | Preventive Medicine | 11159 Corte Pleno Verano, San Diego, CA 92130-2688 | 2018-02-16 |
| 1295240679 | Robert A Brooks | Preventive Medicine | 149 South Barrington Ave, #346, Los Angeles, CA 90049 | 2017-12-07 |
| 1285145383 | Brett V. Curtis M.d. & Associates, A Professional Corporation | Preventive Medicine | 7428 Redwood Blvd Ste 100, Novato, CA 94945-2418 | 2017-10-16 |
| 1104355783 | Susan Bradshaw | Preventive Medicine | 6320 W Howard Drollinger Way Ste 203, Los Angeles, CA 90045-3627 | 2017-06-07 |
| 1386097806 | Healthstat Wellness Bac Madera | Preventive Medicine | 15341 Road 28 1/2, Madera, CA 93638-2325 | 2016-07-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.