Provider Demographics
NPI:1740251875
Name:LESSANE, BEVERLY J (MD)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:J
Last Name:LESSANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5086
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0517
Mailing Address - Country:US
Mailing Address - Phone:704-791-4867
Mailing Address - Fax:704-933-1616
Practice Address - Street 1:521 N CANNON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3801
Practice Address - Country:US
Practice Address - Phone:704-933-2418
Practice Address - Fax:704-933-1616
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC39515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC895173GMedicaid
2183996BMedicare PIN
F53238Medicare UPIN