Provider Demographics
NPI:1285614206
Name:LESHER, DONALD TICE (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:TICE
Last Name:LESHER
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:PO BOX 886
Mailing Address - Street 2:447 NORTH WASHINGTON ST
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-0886
Mailing Address - Country:US
Mailing Address - Phone:828-287-3194
Mailing Address - Fax:828-287-3582
Practice Address - Street 1:131 WEST 2ND ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-0886
Practice Address - Country:US
Practice Address - Phone:828-287-2984
Practice Address - Fax:828-287-3582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951753Medicaid
C87549Medicare UPIN
NC8951753Medicaid