Healthcare Provider Details

I. General information

NPI: 1093776239
Provider Name (Legal Business Name): BARBARA LIGHT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD MAP 2 SUITE 1116
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD MAP 2 SUITE 1116
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-8612
  • Fax:
Mailing address:
  • Phone: 302-368-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2-0006575
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: