Healthcare Provider Details

I. General information

NPI: 1740496942
Provider Name (Legal Business Name): JOSEPH MARTIN LIGHTSEY M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 WEST MORGAN STREET
RALEIGH NC
27699-4278
US

IV. Provider business mailing address

831 WEST MORGAN STREET
RALEIGH NC
27699
US

V. Phone/Fax

Practice location:
  • Phone: 919-838-3825
  • Fax:
Mailing address:
  • Phone: 919-838-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number23603
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: