Provider Demographics
NPI:1982696183
Name:LESESNE, EDWARD H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:LESESNE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-1409
Mailing Address - Country:US
Mailing Address - Phone:828-627-2211
Mailing Address - Fax:828-627-2216
Practice Address - Street 1:6750 CAROLINA BLVD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7052
Practice Address - Country:US
Practice Address - Phone:828-627-2211
Practice Address - Fax:828-627-2216
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC16410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951748Medicaid
NC8951748Medicaid
NCC87546Medicare UPIN