Provider Demographics
NPI:1477516193
Name:LIGHTMAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:LIGHTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:88 HARDEES DR
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7062
Mailing Address - Country:US
Mailing Address - Phone:570-966-5582
Mailing Address - Fax:
Practice Address - Street 1:66 ENTERPRISE BLVD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:PA
Practice Address - Zip Code:17810-9260
Practice Address - Country:US
Practice Address - Phone:866-995-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036811-E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001059577Medicaid
PA0010595770006OtherMEDICAID DUBOIS
PA471957OtherBCBS
PA0004481910OtherAETNA
PA0010595770007OtherMEDICAID MUNCY
PA0010595770009OtherMEDICAID WILLIAMSPORT
PA218286OtherUPMC
PA779726OtherUNITED HEALTHCARE
PA0010595770003OtherMEDICAID LEWISBURG
PA069918OtherFIRST PRIORITY HEALTH
PA180038275OtherRAILROAD MEDICARE
PA01072101OtherCAPITAL BC
PA372894OtherHEALTH AMERICA
PA469-5365OtherGEISINGER HEALTH PLAN
PA01072101OtherCAPITAL BC
PA001059577Medicaid