Provider Demographics
NPI:1740248558
Name:LUSCHER, LENNY (PA)
Entity type:Individual
Prefix:
First Name:LENNY
Middle Name:
Last Name:LUSCHER
Suffix:
Gender:M
Credentials:PA
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3602
Practice Address - Country:US
Practice Address - Phone:910-642-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103387363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740248558Medicaid
SC1974PAMedicaid
NC8102023Medicaid
NC2753180AMedicare PIN
NCS46939Medicare UPIN
NCNC2444BMedicare PIN
NCNC2444AMedicare PIN
NCNC2444EMedicare PIN
NCNC2444FMedicare PIN
NC2753180Medicare PIN
NC8102023Medicaid
SC1974PAMedicaid