1629062120 NPI number — LAURENCE EDWARD LESSER DC

Table of content: LAURENCE EDWARD LESSER DC (NPI 1629062120)

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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