Provider Demographics
NPI:1396717385
Name:LIGMAN, CATHLEEN MARIE (MD)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARIE
Last Name:LIGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S FAIRMONT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5113
Mailing Address - Country:US
Mailing Address - Phone:209-367-1878
Mailing Address - Fax:209-367-1896
Practice Address - Street 1:845 S FAIRMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5113
Practice Address - Country:US
Practice Address - Phone:209-367-1878
Practice Address - Fax:209-367-1896
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0102080Medicaid
CAI42921Medicare UPIN
CAGR0102080Medicaid