Provider Demographics
NPI:1548405020
Name:PREMIER OBGYN
Entity Type:Organization
Organization Name:PREMIER OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHASHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-352-4007
Mailing Address - Street 1:4175 N HANSON CT
Mailing Address - Street 2:#304
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3179
Mailing Address - Country:US
Mailing Address - Phone:301-352-4007
Mailing Address - Fax:301-352-3316
Practice Address - Street 1:4175 N HANSON CT
Practice Address - Street 2:#304
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3179
Practice Address - Country:US
Practice Address - Phone:301-352-4007
Practice Address - Fax:301-352-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty