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NPI 1699768192

NPI 1699768192 : LESLY T MEGA MD : GREENVILLE, NC

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General NPI Number Information
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    NPI Number           |    1699768192
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    Entity Type          |    Individual 
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    Provider Name        |    LESLY T MEGA MD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    08/30/2005
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    Last Update Date     |    03/30/2012
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Provider Practice Location Address
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    Address Line         |    905 JOHNS HOPKINS DR ECU PHYSICIANS PSYCHIATRIC CENTER
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    City                 |    GREENVILLE
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    State                |    NC
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    Zip                  |    27834-7225
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    Country              |    US
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    Telephone            |    252-744-1406
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    Fax                  |    252-744-2419
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Provider Business Mailing Address
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    Address Line         |    PO BOX 751069 
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    City                 |    CHARLOTTE
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    State                |    NC
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    Zip                  |    28275-1069
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    2084P0804X
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    Taxonomy Name        |    Child & Adolescent Psychiatry Physician
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    License Number       |    26320
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    License Number State |    NC
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