Provider Demographics
NPI:1003006412
Name:LESLIE H FENTON MD
Entity Type:Organization
Organization Name:LESLIE H FENTON MD
Other - Org Name:LESLIE H FENTON MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-365-0266
Mailing Address - Street 1:6614 MELODY LANE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-365-0266
Mailing Address - Fax:301-365-3253
Practice Address - Street 1:6614 MELODY LANE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-365-0266
Practice Address - Fax:301-365-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2853207R00000X
MDD01254207R00000X
VA0101016877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty