Healthcare Provider Details

I. General information

NPI: 1003220849
Provider Name (Legal Business Name): CASSANDRA ALYS LIGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIE ALYS LIGH NICKNAME

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

2929 ARCH ST FL 12
PHILADELPHIA PA
19104-2857
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2208
  • Fax: 267-425-9552
Mailing address:
  • Phone: 267-425-9505
  • Fax: 267-443-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD460959
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: