Provider Demographics
NPI:1528286895
Name:PETER LICHT M.D. & JENNIFER HOLLOWAY M.D LLC.
Entity type:Organization
Organization Name:PETER LICHT M.D. & JENNIFER HOLLOWAY M.D LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-426-8442
Mailing Address - Street 1:172 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1443
Mailing Address - Country:US
Mailing Address - Phone:203-426-8442
Mailing Address - Fax:
Practice Address - Street 1:172 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1443
Practice Address - Country:US
Practice Address - Phone:203-426-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004260668Medicaid
CTDB9294OtherRAILROAD MEDICAR