Provider Demographics
NPI:1699050039
Name:ROLF, LESTER LEO JR (MAC)
Entity type:Individual
Prefix:MR
First Name:LESTER
Middle Name:LEO
Last Name:ROLF
Suffix:JR
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 FITZWATER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1815
Mailing Address - Country:US
Mailing Address - Phone:215-546-0403
Mailing Address - Fax:
Practice Address - Street 1:1835 FITZWATER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1815
Practice Address - Country:US
Practice Address - Phone:215-546-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist