Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | MD029219E | PA |
NPI | 1144294497 |
---|---|
Provider Name | Stuart Robert Lessin |
First Address | Bryn Mawr, PA 19010-1352 |
Second Address | Bryn Mawr, PA 19010-1352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016366280005 | (05) | PA |