Provider Demographics
NPI:1184670143
Name:LESH, CHARLES J JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:LESH
Suffix:JR
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 8000 DEPT 570
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-535-0741
Mailing Address - Fax:716-650-5745
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-298-2356
Practice Address - Fax:716-298-2099
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2389252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00027665602OtherUNIVERA
197595FFOtherPREFERRED CARE
0121136OtherGHI
000528627001OtherBLUE SHIELD WNY
NY02783526Medicaid
1613651OtherINDEPENDENT HEALTH
000528627005OtherBLUE SHIELD WNY
P00356171OtherRR MEDICARE
00027665601OtherUNIVERA
NY2389252WOtherWORKERS COMPENSATION
P010238925OtherBLUE CHOICE
P020238925OtherBLUE SHIELD ROCHESTER
NY02783526Medicaid
00027665601OtherUNIVERA
P010238925OtherBLUE CHOICE
RB2808Medicare PIN