Provider Demographics
NPI:1124182472
Name:R. LESLIE SHELTON, M.D., P.C.
Entity Type:Organization
Organization Name:R. LESLIE SHELTON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-840-6481
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-840-6481
Mailing Address - Fax:978-840-0506
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-840-6481
Practice Address - Fax:978-840-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18235OtherBLUE CROSS
MAM18235OtherBLUE CROSS