Provider Demographics
NPI:1629035530
Name:LIGHT, ANDREW IRA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:IRA
Last Name:LIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1089 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7489
Mailing Address - Country:US
Mailing Address - Phone:704-864-8377
Mailing Address - Fax:704-864-4442
Practice Address - Street 1:1089 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7489
Practice Address - Country:US
Practice Address - Phone:704-864-8377
Practice Address - Fax:704-864-4442
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC00-32756208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0642796-002OtherCIGNA
NC17-41296OtherUNITED HEALTH CARE
NY51932OtherBCBS NC
NC020021344OtherRR MEDICARE
NC11947OtherPARTNERS
NC2029703OtherAETNA/USHC HMO
NC35390OtherMEDCOST
NC256269OtherMAMSI
NC4457934OtherAETNA/USHC
NC8951932Medicaid
NC256269OtherMAMSI
NCD92759Medicare UPIN