Provider Demographics
NPI:1174688915
Name:GAVORA, LESLIE HUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:HUGH
Last Name:GAVORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-207-8600
Mailing Address - Fax:703-207-9224
Practice Address - Street 1:2671B AVENIR PL
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7176
Practice Address - Country:US
Practice Address - Phone:703-207-8600
Practice Address - Fax:703-207-9224
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2024-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101040171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine