1629062120 NPI number — LAURENCE EDWARD LESSER DC

Table of content: BETTY TAYLOR (NPI 1336293661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629062120 NPI number — LAURENCE EDWARD LESSER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESSER
Provider First Name:
LAURENCE
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1629062120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10411 COURTHOUSE RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SPOTSYLVANIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22553-1798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-891-9191
Provider Business Mailing Address Fax Number:
540-891-9225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10411 COURTHOUSE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPOTSYLVANIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22553-1798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-891-9191
Provider Business Practice Location Address Fax Number:
540-891-9225
Provider Enumeration Date:
09/12/2005

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: 111N00000X , with the licence number:  0104001252 , 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)

  • Identifier: 8940258 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258995 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2069101 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76579 . This is a "SOUTHERN HEALTH INSURANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 107097 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5518015 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".




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