Provider Demographics
NPI:1144294497
Name:LESSIN, STUART ROBERT (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:ROBERT
Last Name:LESSIN
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 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING 2, SUITE 106
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-5028
Mailing Address - Fax:610-525-2494
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING 2, SUITE 106
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-5028
Practice Address - Fax:610-525-2494
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029219174400000X
PAMD029219E207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016366280005Medicaid
PA0016366280005Medicaid