DR. JENIFER R LIGHTDALE (NPI# 1932112380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932112380 |
| Entity Type | Individual |
| Full Name | DR. JENIFER R LIGHTDALE |
| Credential | MD |
| Practice Address |
55 Lake Ave N Worcester MA 01655-0002 |
| Mailing Address |
Po Box 415348 Boston MA 02241-5348 |
| Practice Telephone | 7744418082 |
| Practice Fax Number | 7744418056 |
| Mailing Telephone | 8002258885 |
| Mailing Fax Number | 5083341977 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-10-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 208223 | MA | Allopathic & Osteopathic Physicians |
| Y | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
208223 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | MEDICARE | A3343901 | 01 |
| MA | 110005111A | 05 |
| Street Address |
55 LAKE AVE N |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556587 | James E Liebmann | Internal Medicine | 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 | 2005-05-23 |
| 1518568732 | Justin Bullard | Psychologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-11-04 |
| 1346849825 | Meghan Moore | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-26 |
| 1174122899 | Jessica Goncalves Ferreira | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-23 |
| 1235746686 | Desiree Mytych | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-29 |
| 1659986248 | Rebecca Lynn Harris | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-10 |
| 1639781487 | Gabriella Kathleen Holland | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-21 |
| 1730791898 | Kerry Anne Benedict | Speech-Language Pathologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1902418999 | Natasha R. Turner | Genetic Counselor, MS | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1144830712 | Abbey Corsini | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205489713 | Darryl Sweeper Jr. | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-23 |
| 1225690530 | Ryan Zenevitch | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-08 |
| 1932688454 | Victoria Sayeg | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 | 2018-08-07 |
| 1114425675 | Judith Dio Wentzell | Social Worker | Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 | 2018-01-30 |
| 1861927386 | Muhammad Waqas Khan | Student in an Organized Health Care Education/Training Program | University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 | 2017-04-21 |
| 1861806192 | Qaiser Shamshir Khan | Psychiatry & Neurology | 55 Lake Ave N # S7-831, Worcester, MA 01655 | 2014-06-14 |
| 1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
| 1972867992 | Anna Bjornsdottir | Psychiatry & Neurology | 55 Lake Av N, Worcester, MA 01655 | 2012-06-25 |
| 1245567676 | Steven Edward Mckinley | Nurse Practitioner | 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 | 2009-11-05 |
| 1851582951 | Robin I Davidson | Neurological Surgery | 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 | 2007-08-05 |
| Find all providers in zip 01655 | ||||
| Taxonomy Code | 2080P0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Gastroenterology |
| A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114195179 | Central Mass Pediatric Gi & Nutrition, P.C. | Pediatrics | 123 Summer Street, Suite 630, Worcester, MA 01608 | 2008-02-13 |
| 1801977640 | Jay G. Fong | Pediatrics | 55 Lake Ave North, Worcester, MA 01655 | 2006-10-18 |
| 1265485767 | Idris Z Dahod | Pediatrics | 123 Summer St, Worcester, MA 01608-1200 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467691329 | Wael N. Sayej | Pediatrics | 50 Wason Ave Fl 1, Springfield, MA 01107-1280 | 2009-02-16 |
| 1063674414 | Alexandra N Carey | Pediatrics | 333 Longwood Ave Fl 4, Division of Pediatric Gastroenterology and Nutrition, Boston, MA 02115-5711 | 2008-06-26 |
| 1437335239 | Khoa Dang Tran | Pediatrics | 800 Washington St, Box# 286, Tufts Medical Center, Department of Pediatrics, Boston, MA 02111-1552 | 2008-01-11 |
| 1881700706 | Uzma Shah | Pediatrics | 175 Cambridge Street, Cpzs-575, Boston, MA 02114-2743 | 2006-08-22 |
| 1700803160 | Elizabeth J Hait | Pediatrics | Childrens Hospital, 300 Longwood Avenue, Boston, MA 02115 | 2006-07-15 |
| 1144209446 | William Alian Walker | Pediatrics | 55 Fruit Street B114 3501, Massachusetts General Hospital, Boston, MA 02114 | 2006-01-13 |
| 1265413009 | Anastasios G Angelides | Pediatrics | 50 Wason Ave, 1st Fl, Springfield, MA 01107-1274 | 2005-11-09 |
| 1891355715 | Kathryn Broyles | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2019-06-13 |
| 1477049468 | Abigail Francis Cross | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2018-07-03 |
| 1356768816 | Jessica Lacy Yasuda | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2014-03-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.