Provider Demographics
NPI:1376535112
Name:HORRELL, LESTER BYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:BYRON
Last Name:HORRELL
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 1:703 N. BRIDGE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:410-398-5930
Mailing Address - Fax:410-398-0165
Practice Address - Street 1:703 N. BRIDGE ST.
Practice Address - Street 2:SUITE 104
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-398-5930
Practice Address - Fax:410-398-0165
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007400400Medicaid
MDF76738Medicare UPIN