Provider Demographics
NPI:1164415840
Name:LECKER, SHARI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:
Last Name:LECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-396-1288
Mailing Address - Fax:781-391-1989
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-396-1288
Practice Address - Fax:781-391-1989
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA051421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG19335Medicare UPIN