1245227750 NPI number — LESTER S PEARLSTEIN PHD

Table of content: LEISA MARIE JONES RN (NPI 1417299397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245227750 NPI number — LESTER S PEARLSTEIN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARLSTEIN
Provider First Name:
LESTER
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245227750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 TASMANIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREE UNION
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22940-1939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-973-3835
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-971-4747
Provider Business Practice Location Address Fax Number:
434-293-4690
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810000882 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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