Provider Demographics
NPI:1912136946
Name:LIGHT, RYAN EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EUGENE
Last Name:LIGHT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:1100 VOLVO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3341
Practice Address - Country:US
Practice Address - Phone:757-389-5370
Practice Address - Fax:757-389-5381
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2012-09-25
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Provider Licenses
StateLicense IDTaxonomies
VA0116021359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine