Provider Demographics
NPI:1275504615
Name:MCDONALD, LESTER JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:JAY
Last Name:MCDONALD
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164439-1207W00000X
PAMD050522L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA180040319OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
NYP00173981OtherRR MEDICARE PIN
PA0014414760004Medicaid
NY01170983Medicaid
PA180040319OtherRR MEDICARE GROUP
PAGU039847OtherPA MEDICARE GROUP
NYCC2114Medicare ID - Type Unspecified
NYCC8362OtherRR MEDICARE GROUP
E78403Medicare UPIN