Organization Active NPI

Lighthouse Internal Medicine P.a.

  • Internal Medicine Physician
  • Milford, DE
National Provider Identifier
1417903048
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C100006175 Issued in DE
Legal business name
LIGHTHOUSE INTERNAL MEDICINE P.A.
Practice address
909 Lakeview Ave
Milford, DE 19963-1731
Phone
(302) 422-5506
Fax
(302) 422-5507
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Josie Walters
Title
Office Manager
Phone
(302) 422-5506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X C100006175 DE Primary

Addresses

Primary practice location

909 Lakeview Ave
Milford, DE 19963-1731

Mailing address

909 Lakeview Ave
Milford, DE 19963-1731
Phone (302) 422-5506

Other identifiers 3

IdentifierTypeStateIssuer
1000036273OtherDEDELAWARE PHYSICIANS CARE
DD5833OtherDERAIL ROAD MEDICARE
1000036273MedicaidDE

National Provider Directory

National Provider Directory

Locations

909 Lakeview Ave
Milford, DE 19963
Phone (302) 422-6038

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1417903048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 LAKEVIEW AVE",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631731",
            "telephone_number": "302-422-5506",
            "fax_number": "302-422-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 LAKEVIEW AVE",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631731",
            "telephone_number": "302-422-5506",
            "fax_number": "302-422-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE INTERNAL MEDICINE P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "JOSIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "302-422-5506"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "DE",
            "license": "C100006175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELAWARE PHYSICIANS CARE",
            "identifier": "1000036273",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DD5833",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000036273",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.