Provider Demographics
NPI:1578567921
Name:LIGHT, WILMA C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILMA
Middle Name:C
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1100 LIGONIER ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1978
Mailing Address - Country:US
Mailing Address - Phone:724-539-4551
Mailing Address - Fax:724-539-0835
Practice Address - Street 1:1100 LIGONIER ST
Practice Address - Street 2:STE 200
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1978
Practice Address - Country:US
Practice Address - Phone:724-539-4551
Practice Address - Fax:724-539-0835
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD017517E207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101296OtherUPMC
PA140772OtherHIGHMARK
PA101296OtherBEST HEALTH
PA5348794OtherFIRST HEALTH
PA0006055920001Medicaid
PA0480153OtherAETNA
PA66243OtherMED PLUS
PA9973519002OtherCIGNA
PA5348794OtherFIRST HEALTH
PA66243OtherMED PLUS