1477516193 NPI number — DAVID A LIGHTMAN MD

Table of content: DAVID A LIGHTMAN MD (NPI 1477516193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477516193 NPI number — DAVID A LIGHTMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIGHTMAN
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1477516193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 HARDEES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIFFLINBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17844-7062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-966-5582
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 ENTERPRISE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17810-9260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-995-3937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006

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: 207W00000X , with the licence number:  MD036811-E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001059577 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010595770006 . This is a "MEDICAID DUBOIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 471957 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004481910 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010595770007 . This is a "MEDICAID MUNCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010595770009 . This is a "MEDICAID WILLIAMSPORT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 218286 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 779726 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010595770003 . This is a "MEDICAID LEWISBURG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 069918 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 180038275 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01072101 . This is a "CAPITAL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 372894 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 469-5365 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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