Provider Demographics
NPI:1831112937
Name:LESZNIK, GEORGE R (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:LESZNIK
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:PO BOX 1351
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-1351
Mailing Address - Country:US
Mailing Address - Phone:802-886-8950
Mailing Address - Fax:802-885-2030
Practice Address - Street 1:25 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3050
Practice Address - Country:US
Practice Address - Phone:802-885-2151
Practice Address - Fax:802-885-2030
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0009961207L00000X
CO27979207L00000X
NJ25MA07056300207L00000X
NC2006-01580207L00000X
VA0101239439207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1831112937Medicaid
VAP00614724Medicare PIN
E04731Medicare UPIN
VA1831112937Medicaid