Provider Demographics
NPI:1649401779
Name:MATSON, LESLIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:MATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1950 GLENN MITCHELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0168
Mailing Address - Country:US
Mailing Address - Phone:757-507-0600
Mailing Address - Fax:757-689-3785
Practice Address - Street 1:1950 GLENN MITCHELL DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0168
Practice Address - Country:US
Practice Address - Phone:757-507-0600
Practice Address - Fax:757-510-9180
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant