Provider Demographics
NPI:1912102013
Name:PEKAREK, LESSLIE (MD)
Entity Type:Individual
Prefix:
First Name:LESSLIE
Middle Name:
Last Name:PEKAREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESSLIE
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX 344054
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-0001
Mailing Address - Country:US
Mailing Address - Phone:864-656-2233
Mailing Address - Fax:864-656-0760
Practice Address - Street 1:735 MCMILLAN RD.
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-4054
Practice Address - Country:US
Practice Address - Phone:864-656-2233
Practice Address - Fax:864-656-0760
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL29772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1801028543OtherBAPTIST EASLEY NPI 1801028543 EFFECTIVE 8-2-2010
SC297725Medicaid
SC1801028543OtherBAPTIST EASLEY NPI 1801028543 EFFECTIVE 8-2-2010
SCRES0001124Medicare PIN
SCRES000Medicare UPIN