Provider Demographics
NPI:1992736169
Name:LESSANS, KENNETH D (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:LESSANS
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 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-393-1771
Mailing Address - Fax:717-393-2782
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604-3200
Practice Address - Country:US
Practice Address - Phone:717-393-1771
Practice Address - Fax:717-393-2782
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056456L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016966260005Medicaid
PA0016966260005Medicaid
008577EMQMedicare PIN