Healthcare Provider Details

I. General information

NPI: 1407869936
Provider Name (Legal Business Name): LESTER CLEGG CAUDLE III M.D., MTM & H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

1 COBLENTZ CT
MIDDLETOWN MD
21769-7857
US

V. Phone/Fax

Practice location:
  • Phone: 703-681-3400
  • Fax:
Mailing address:
  • Phone: 301-371-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0064145
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31716
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: