Provider Demographics
NPI:1215098942
Name:LIEDTKA, JANE E (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:LIEDTKA
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 1:4420 BURLINGTON PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4422
Mailing Address - Country:US
Mailing Address - Phone:202-641-1106
Mailing Address - Fax:
Practice Address - Street 1:4420 BURLINGTON PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4422
Practice Address - Country:US
Practice Address - Phone:202-641-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD000020331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology