Healthcare Provider Details

I. General information

NPI: 1306921481
Provider Name (Legal Business Name): BETTINA B. LESSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRYN MAWR HOSPITAL 130 S. BRYN MAWR AVE.
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 610-526-4618
  • Fax: 610-526-4661
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD050778L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD050778L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: