Healthcare Provider Details

I. General information

NPI: 1780773416
Provider Name (Legal Business Name): VIRGINIA LIGHTNER FAMILY DERMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WHEATON DR
YOUNGSVILLE NC
27596-8691
US

IV. Provider business mailing address

82 WHEATON DR
YOUNGSVILLE NC
27596-8691
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-8887
  • Fax: 919-570-0211
Mailing address:
  • Phone: 919-562-8887
  • Fax: 919-570-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27232
License Number StateNC

VIII. Authorized Official

Name: DR. VIRGINIA A LIGHTNER
Title or Position: OWNER
Credential: MD, PHD
Phone: 919-562-8887