Provider Demographics
NPI:1952483034
Name:GEORGE W. LIGHTY JR. MD, PHD, FACC
Entity Type:Organization
Organization Name:GEORGE W. LIGHTY JR. MD, PHD, FACC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FOLK-LIGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:610-527-9001
Mailing Address - Street 1:551 W LANCASTER AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1419
Mailing Address - Country:US
Mailing Address - Phone:610-527-9001
Mailing Address - Fax:610-527-9004
Practice Address - Street 1:551 W LANCASTER AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1419
Practice Address - Country:US
Practice Address - Phone:610-527-9001
Practice Address - Fax:610-527-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045692L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB81436Medicare UPIN