Provider Demographics
NPI:1003220849
Name:LIGH, CASSANDRA ALYS (MD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:ALYS
Last Name:LIGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:ALYS
Other - Last Name:LIGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICKNAME
Mailing Address - Street 1:2929 ARCH ST FL 12
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2857
Mailing Address - Country:US
Mailing Address - Phone:267-425-9505
Mailing Address - Fax:267-443-1341
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-2208
Practice Address - Fax:267-425-9552
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4609592086S0122X
PAMT2063772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029053OtherKAISER COMMERCIAL NUMBER