Healthcare Provider Details

I. General information

NPI: 1740818780
Provider Name (Legal Business Name): KAILA MARIE LESSNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

14665 FLERLAGE PL
WALDORF MD
20601-9704
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7249
  • Fax:
Mailing address:
  • Phone: 240-682-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101277633
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101277633
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101277633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: