Provider Demographics
NPI:1427059575
Name:LIGHTCAP, KATHRYN (DPM)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LIGHTCAP
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1449
Mailing Address - Country:US
Mailing Address - Phone:302-644-0100
Mailing Address - Fax:302-644-0238
Practice Address - Street 1:334 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1449
Practice Address - Country:US
Practice Address - Phone:302-644-0100
Practice Address - Fax:302-644-0238
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000110213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000629450Medicaid
DE0000629450Medicaid
DE1058570001Medicare NSC
DE476761Medicare PIN