Doctor Name: | MR. MARK E. LESTER |
NPI Number: | 1982685764 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 05007896A |
Business Practice Address: | 11050 Mount Belvedere Blvd Usa Meddac/credentials Fort Drum, NY - 136025438 |
Business Phone Number: | 3157724025 |
Business Fax Number: | 3157729498 |
Mailing Address: | 1 Heritage Ln, NATICK |
State: | MA |
Postal Code: | 017602610 |
Phone Number: | 5082335488 |
Fax Number: | |
NPI Enumeration Date: | 11/09/2005 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 05007896A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |