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Contact Information

GLEN R LIESEGANG, MD
1345 HIGHWAY 268
PATTERSON, NC28661
 Phone: 828-754-6850
 Fax: 828-758-3214
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for GLEN R LIESEGANG · (Male)

NPI Number 1174584866
Status Active
Credentials MD
Entity Individual
Enumeration date 03/31/2006
Last updated 06/18/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • NC License # 31569
  • NC Medicaid 8951919
  • NC Other 51919 BCBS
Hospital affiliation(s)
  • WATAUGA MEDICAL CENTER - (Acute Care)
    336 DEERFIELD ROAD
    BOONE, NC 28607
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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