MEDICARE: VIRGINIA LIGHTNER FAMILY DERMATOLOGY, PA

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	0177R	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1780773416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA LIGHTNER FAMILY DERMATOLOGY, PA

Provider Business Mailing 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

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	:	OWNER
Name	:	DR. VIRGINIA A LIGHTNER
Credential	:	MD, PHD
Telephone Number	:	919-562-8887

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	01/18/2008

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