Provider Demographics
NPI:1285628917
Name:LESAR, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:LESAR
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 1:2358 LIFESTYLE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4907
Mailing Address - Country:US
Mailing Address - Phone:423-602-2750
Mailing Address - Fax:423-602-2762
Practice Address - Street 1:2358 LIFESTYLE WAY STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4907
Practice Address - Country:US
Practice Address - Phone:423-602-2750
Practice Address - Fax:423-602-2762
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37354174400000X, 2085R0204X, 208600000X
TN373542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0180OtherJDH
4060331OtherBCBS OF TN
TNQ002574Medicaid
AL009930885Medicaid
P00010338OtherRR MEDICARE
GA417224689FMedicaid
4655768001OtherCIGNA
GA417224689FMedicaid
TN0180OtherJDH
3883165Medicare ID - Type Unspecified
TN3883165Medicaid
GA417224689CMedicaid
GA417224689DMedicaid
4655768001OtherCIGNA