Dr. Jenifer R Lightdale

MD | Pediatric Gastroenterology | Female

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Complete Profile:

Dr. Jenifer R Lightdale basic information including her official name, gender, specialization, credentials etc. are as mentioned below.

Specialization :	Pediatrics Pediatric Gastroenterology
Provider Name :	Dr. Jenifer R Lightdale
Credential :	MD
Gender :	Female

Business Address:

Dr. Jenifer R Lightdale address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.

Primary Address :	55 Lake Ave N Worcester, MA, 01655-0002 United States
Phone Number :	774-441-8082
Fax Number :	774-441-8056

Professional Identification Codes:

NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.

NPI Number :	1932112380
NPI Entity Type :	Individual
First Enrolment Date :	15 Aug, 2006
Last Updated On :	28 Oct, 2020

Medicare Participation:

Dr. Jenifer R Lightdale participates in medicare and accepts medicare insurance either directly or through association with group practice or medical facility.

Medicare PECOS ID :	1153303458
Medicare Enrollment ID :	I20040602000019
Primary Specialty :	Gastroenterology
Medical School :	Icahn School Of Medicine At Mount Sinai
Graduation Year :	1995
Accepts Medicare?	Yes. Dr. Jenifer R Lightdale accepts medicare insurance.

Group Practice Association:

Dr. Jenifer R Lightdale is associated with following Group Practice Organizations. Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name with which Dr. Jenifer R Lightdale is associated with along with the number of members in that group. She may also accept medicare indirectly via these group practices.

Organisation Name :	Group Practice ID	No. of Members	Practice Address	Group Accepts Medicare
Children's Hospital Pediatric Associates, Inc	3476541830	231	300 Longwood Ave Boston, MA - 021155724 Ph: 6173556000	Yes

Licenses and Specialities:

Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Jenifer R Lightdale are as mentioned. Primary taxonomy code for Dr. Jenifer R Lightdale, MD is 2080P0206X (Pediatrics Pediatric Gastroenterology).

Taxonomy Code	Speciality	Primary	License No.	State
208000000X	Pediatrics	No	208223	MA
2080P0206X	Pediatrics Pediatric Gastroenterology	Yes	208223	MA

Legacy Identifiers:

Other legacy medical identifiers of Dr. Jenifer R Lightdale such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.

Identifier	Identifier Type	State	Issuer
A3343901	Other	MA	MEDICARE
110005111A	MEDICAID	MA

Endpoints:

Endpoints provide a simple, secure, scalable, and standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. It is used by EHR systems (Electronic Health Records).

Mailing Address:

Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.

Mailing Address :	Po Box 415348 Boston, MA, 02241-5348 United States
Phone Number :	800-225-8885
Fax Number :	508-334-1977

Business Location:

Patients can refer following map for directions to Dr. Jenifer R Lightdale practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.