MEDICARE: SUSAN LESTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	200000874	NC

General Provider Information

NPI Number	:	1073513388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LESTER

Provider Business Mailing Address
First Line	:	5727 PROSPERITY CROSSING DRIVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5727 PROSPERITY CROSSING DRIVE
Second Line	:	SUITE 2200
City	:	CHARLOTTE
State	:	NC
Zip	:	28269
Country	:	US
Telephone Number	:	704-863-9830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	02/13/2019

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Directions to “ SUSAN LESTER ” Practice Location

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