Provider Demographics
NPI:1669584686
Name:LIGHAM, DWIGHT PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:PAUL
Last Name:LIGHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 LONG WHARF DRIVE # 212
Mailing Address - Street 2:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER PC
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-624-4208
Mailing Address - Fax:203-624-4301
Practice Address - Street 1:1 LONG WHARF DRIVE
Practice Address - Street 2:SUITE 212
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-624-4208
Practice Address - Fax:203-624-4301
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-01-25
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Provider Licenses
StateLicense IDTaxonomies
CT034195207LP2900X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF94775Medicare UPIN
CT050001109Medicare PIN