Provider Demographics
NPI:1144272915
Name:EARLL, LESLIE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
Last Name:EARLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2709 BLAINE DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3041
Mailing Address - Country:US
Mailing Address - Phone:301-944-4392
Mailing Address - Fax:301-933-5108
Practice Address - Street 1:7555 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9783
Practice Address - Country:US
Practice Address - Phone:443-204-6914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00434452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0043445OtherSTATE LICENSE
MDD0043445OtherSTATE LICENSE
OOG832230Medicare ID - Type Unspecified