MEDICARE: DR. WILMA C LIGHT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	MD017517E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101296	OTHER	PA	UPMC
2	140772	OTHER	PA	HIGHMARK
3	101296	OTHER	PA	BEST HEALTH
4	5348794	OTHER	PA	FIRST HEALTH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0480153	OTHER	PA	AETNA
7	66243	OTHER	PA	MED PLUS
8	9973519002	OTHER	PA	CIGNA

General Provider Information

NPI Number	:	1578567921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILMA C LIGHT MD

Provider Business Mailing Address
First Line	:	1100 LIGONIER ST
Second Line	:	STE 200
City	:	LATROBE
State	:	PA
Zip	:	15650-1978
Country	:	US
Telephone Number	:	724-539-4551
Fax Number	:	724-539-0835

Provider Business Practice Location Address
First Line	:	1100 LIGONIER ST
Second Line	:	STE 200
City	:	LATROBE
State	:	PA
Zip	:	15650-1978
Country	:	US
Telephone Number	:	724-539-4551
Fax Number	:	724-539-0835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/28/2010

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Directions to “ DR. WILMA C LIGHT MD” Practice Location

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