MEDICARE: DR. SAMUEL MATTHEW LESKO M.D., M.P.H.

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	54784	MA
2	207Q00000X	Family Medicine Physician	MD-070771-L	PA

General Provider Information

NPI Number	:	1245212430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL MATTHEW LESKO M.D., M.P.H.

Provider Business Mailing Address
First Line	:	360 GRAVEL POND RD
Second Line	:
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-9473
Country	:	US
Telephone Number	:	570-587-2515
Fax Number	:

Provider Business Practice Location Address
First Line	:	334 JEFFERSON AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18510-2438
Country	:	US
Telephone Number	:	570-941-7984
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/08/2007

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