Healthcare Provider Details

I. General information

NPI: 1689898884
Provider Name (Legal Business Name): KAREN LEE LIGHT M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-5257
  • Fax:
Mailing address:
  • Phone: 610-874-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD050873L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD050873L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: