Healthcare Provider Details

I. General information

NPI: 1144294497
Provider Name (Legal Business Name): STUART ROBERT LESSIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CONESTOGA RD BUILDING 2, SUITE 106
BRYN MAWR PA
19010-1352
US

IV. Provider business mailing address

919 CONESTOGA RD BUILDING 2, SUITE 106
BRYN MAWR PA
19010-1352
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-5028
  • Fax: 610-525-2494
Mailing address:
  • Phone: 610-525-5028
  • Fax: 610-525-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD029219
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD029219E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: