MEDICARE: DR. VIRGINIA A. LIGHTNER M.D., PHD

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	207N00000X	Dermatology Physician	27232	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260401	OTHER	NC	MAMSI
2	2069198	OTHER	NC	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	11647	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770557878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA A. LIGHTNER M.D., PHD

Provider Business Mailing Address
First Line	:	PO BOX 63362
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28263-3362
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 WHEATON DR
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-8691
Country	:	US
Telephone Number	:	919-562-8887
Fax Number	:	919-570-0211

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	06/26/2013

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