Provider Demographics
NPI:1003874587
Name:LESSNER-BOESLER, SUSAN MARIE (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:LESSNER-BOESLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 OAK HOLW
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8918
Mailing Address - Country:US
Mailing Address - Phone:757-206-6595
Mailing Address - Fax:
Practice Address - Street 1:124 OAK HOLW
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8918
Practice Address - Country:US
Practice Address - Phone:757-206-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202443207P00000X
MI5101012764207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG58783Medicare UPIN