Provider Demographics
NPI:1962147603
Name:LICHTENSTEIN, ISAAC ANSON (MD, RN)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:ANSON
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:MD, RN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E 33RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2776
Mailing Address - Country:US
Mailing Address - Phone:360-995-1126
Mailing Address - Fax:360-514-7587
Practice Address - Street 1:3600 NW SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5472
Practice Address - Country:US
Practice Address - Phone:541-768-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG211324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine