MEDICARE: DR. RICHARD LIGHTBODY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	35042341	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194707174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LIGHTBODY MD

Provider Business Mailing Address
First Line	:	2264 N SAINT JAMES PKWY
Second Line	:	SIDE ENTRANCE
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3658
Country	:	US
Telephone Number	:	216-371-1268
Fax Number	:	216-371-2242

Provider Business Practice Location Address
First Line	:	2264 N SAINT JAMES PKWY
Second Line	:	SIDE ENTRANCE
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3658
Country	:	US
Telephone Number	:	216-371-1268
Fax Number	:	216-371-2242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/07/2023

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