Provider Demographics
NPI:1306921481
Name:LESSER, BETTINA B (MD)
Entity type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:B
Last Name:LESSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:BRYN MAWR HOSPITAL
Practice Address - Street 2:130 S. BRYN MAWR AVE.
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:610-526-4618
Practice Address - Fax:610-526-4661
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD050778L208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1512059Medicaid
MD7214049Medicaid
G00315Medicare UPIN
633519Medicare PIN