Provider Demographics
NPI:1639109994
Name:LESNOSKI, PAUL E (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:LESNOSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5008
Mailing Address - Country:US
Mailing Address - Phone:330-726-3000
Mailing Address - Fax:330-726-2612
Practice Address - Street 1:901 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5008
Practice Address - Country:US
Practice Address - Phone:330-726-3000
Practice Address - Fax:330-726-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0877163Medicaid
OH78240OtherHEALTH ASSURANCE
OHQ005055OtherHOMETOWN
OH000000243202OtherANTHEM BC/BS
OH101710OtherUNITED HEALTHCARE
OH341341025033OtherCARESOURCE
OHZ05094OtherSUMMACARE
OH0877163Medicaid
OH101710OtherUNITED HEALTHCARE