MEDICARE: DR. THOMAS PETER LESSARIS MD

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	208000000X	Pediatrics Physician	200000517	NC
2	207R00000X	Internal Medicine Physician	200000517	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275580706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PETER LESSARIS MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-5635
Fax Number	:	704-316-5640

Provider Business Practice Location Address
First Line	:	9615 KINCEY AVE
Second Line	:	SUITE 100
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9140
Country	:	US
Telephone Number	:	704-316-5635
Fax Number	:	704-316-5640

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/29/2022

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