Provider Demographics
NPI:1073749461
Name:BROWN, LESLI ANTOINETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLI
Middle Name:ANTOINETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4700 PUDDLEDOCK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1268
Mailing Address - Country:US
Mailing Address - Phone:804-526-1111
Mailing Address - Fax:804-526-2978
Practice Address - Street 1:4700 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1268
Practice Address - Country:US
Practice Address - Phone:804-526-1111
Practice Address - Fax:804-526-2978
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2015-06-16
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Provider Licenses
StateLicense IDTaxonomies
VA0101251204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV7124AMedicare PIN