Provider Demographics
NPI:1063673507
Name:LEVESQUE, JESSICA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-3593
Mailing Address - Fax:518-262-6014
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3593
Practice Address - Fax:518-262-6014
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62711390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program