Provider Demographics
NPI:1083296479
Name:LESAVAGE, LINDSAY (DPM)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:LESAVAGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MOUNT VERNON ST APT 405
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3474
Mailing Address - Country:US
Mailing Address - Phone:813-992-1354
Mailing Address - Fax:
Practice Address - Street 1:2150 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4241
Practice Address - Country:US
Practice Address - Phone:336-716-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program