Provider Demographics
NPI:1508832130
Name:DAVIS, LESLIE LYNT (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 KOGER CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4778
Mailing Address - Country:US
Mailing Address - Phone:804-897-2100
Mailing Address - Fax:804-897-9074
Practice Address - Street 1:1212 KOGER CENTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4778
Practice Address - Country:US
Practice Address - Phone:804-897-2100
Practice Address - Fax:804-897-9074
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA160001636Medicaid
G92372Medicare UPIN
6212999Medicare ID - Type Unspecified