Provider Demographics
NPI:1265433361
Name:BESNER, LANCE ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ALAN
Last Name:BESNER
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 1:120 E 2ND ST
Mailing Address - Street 2:SUITE 348
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-459-4459
Mailing Address - Fax:814-459-4957
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:SUITE 348
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-459-4459
Practice Address - Fax:814-459-4957
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045133E103G00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE42744Medicare UPIN