Basic Information
| Provider Information | |||||||||
| NPI: | 1356425276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | LESCO | ||||||||
| MiddleName: | LLOYD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 PARK RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043232377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1604 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102764611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 9601048 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | G29349 | 01 | FL | MEDICARE PIN | OTHER | 103I721217 | 01 | FL | MEDICARE PIN | OTHER | 2048080 | 01 | FL | MEDICARE ID | OTHER | 8972980 | 01 | FL | MEDICARE UPIN | OTHER |