Healthcare Provider Details

I. General information

NPI: 1164959243
Provider Name (Legal Business Name): JOHANNA ELIZABETH LIGHTCAP DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 SAVANNAH RD
LEWES DE
19958-1449
US

IV. Provider business mailing address

334 SAVANNAH RD
LEWES DE
19958-1449
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-0100
  • Fax: 302-644-0238
Mailing address:
  • Phone: 302-644-0100
  • Fax: 302-644-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1-0010265
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: