Provider Demographics
NPI:1336139021
Name:VENSEL, LESLIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:VENSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:781-487-4350
Mailing Address - Fax:781-487-4351
Practice Address - Street 1:40 2ND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1132
Practice Address - Country:US
Practice Address - Phone:781-487-4350
Practice Address - Fax:781-487-4351
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA57348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3054799Medicaid
MA713954OtherTUFTS HEALTH PLAN
MAJ09081OtherBCBS MA
MA3054799Medicaid
MA713954OtherTUFTS HEALTH PLAN