1093776239 NPI number — DR. BARBARA LIGHT DO

Table of content: DR. BARBARA LIGHT DO (NPI 1093776239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093776239 NPI number — DR. BARBARA LIGHT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIGHT
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093776239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4735 OGLETOWN STANTON RD
Provider Second Line Business Mailing Address:
MAP 2 SUITE 1116
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-368-8612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4735 OGLETOWN STANTON RD
Provider Second Line Business Practice Location Address:
MAP 2 SUITE 1116
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-368-8612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  C2-0006575 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180061 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 7010364 . This is a "AETNA USHC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: H72664 . This is a "MID ATLANTIC HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1425271 . This is a "AMERIHEALTH - PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000015432 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000015432 . This is a "DELAWARE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000015432 . This is a "DIAMOND STATE HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 615622-02 . This is a "BC/BS MD PCP #" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2110792000 . This is a "AMERIHEALTH - HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 262908 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: H72664 . This is a "BC/BS DE PCP #" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2110792000 . This is a "KEYSTONE EAST HMO (SEE AM" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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