Provider Demographics
NPI:1003543190
Name:LESLY S. DAVIDSON, MD, PA
Entity Type:Organization
Organization Name:LESLY S. DAVIDSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-906-3980
Mailing Address - Street 1:901 VON KOLNITZ RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3772
Mailing Address - Country:US
Mailing Address - Phone:843-216-3376
Mailing Address - Fax:843-216-3242
Practice Address - Street 1:901 VON KOLNITZ RD STE 100
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3772
Practice Address - Country:US
Practice Address - Phone:843-216-3376
Practice Address - Fax:843-216-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty