Provider Demographics
NPI:1245212430
Name:LESKO, SAMUEL MATTHEW (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MATTHEW
Last Name:LESKO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 GRAVEL POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9473
Mailing Address - Country:US
Mailing Address - Phone:570-587-2515
Mailing Address - Fax:
Practice Address - Street 1:334 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2438
Practice Address - Country:US
Practice Address - Phone:570-941-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54784207Q00000X
PAMD-070771-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine