Provider Demographics
NPI:1356447320
Name:LESCANIC, MICHAEL LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:LESCANIC
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 1:2459 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3362
Mailing Address - Country:US
Mailing Address - Phone:814-234-4537
Mailing Address - Fax:
Practice Address - Street 1:101 REGENT CT
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7965
Practice Address - Country:US
Practice Address - Phone:814-231-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038625E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA63183OtherHIGHMARK BLUE SHIELD
PA02990101OtherKEYSTONE HEALTH PLAN CENT
PA8733991BOtherGEISINGER HEALTH PLAN
PALEO63183OtherCHAMPUS
PA0011221890005Medicaid
PA02990101OtherCAPITAL BLUE CROSS
PA02990101OtherCAPITAL BLUE CROSS
PA02990101OtherKEYSTONE HEALTH PLAN CENT