Provider Demographics
NPI:1598022204
Name:LEFFEL, WENDY L (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:LEFFEL
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 1:1151 NW HILL RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261-9448
Mailing Address - Country:US
Mailing Address - Phone:802-558-5656
Mailing Address - Fax:
Practice Address - Street 1:339 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2253
Practice Address - Country:US
Practice Address - Phone:802-445-3039
Practice Address - Fax:802-445-3026
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009231207QA0401X
MA265685207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1652Medicaid