Provider Demographics
NPI:1003973165
Name:LESSIN, BRUCE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:LESSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 DOLLEY MADISON BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3953
Mailing Address - Country:US
Mailing Address - Phone:703-821-1677
Mailing Address - Fax:703-821-2880
Practice Address - Street 1:1313 DOLLEY MADISON BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3953
Practice Address - Country:US
Practice Address - Phone:703-821-1677
Practice Address - Fax:703-821-2880
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
179476Medicare ID - Type Unspecified
VAB94269Medicare UPIN