Provider Demographics
NPI:1265514913
Name:LESTER, MARK
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FORBES STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-263-6363
Mailing Address - Fax:410-263-4086
Practice Address - Street 1:200 FORBES STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-263-6363
Practice Address - Fax:410-263-4086
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BL9984926OtherDEA