Provider Demographics
NPI:1730315698
Name:LAURETA, LENNY (DO)
Entity Type:Individual
Prefix:DR
First Name:LENNY
Middle Name:
Last Name:LAURETA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LENNY
Other - Middle Name:
Other - Last Name:LAURETA-BANSIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1101 MADISON PLZ STE 201
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5179
Mailing Address - Country:US
Mailing Address - Phone:757-547-2322
Mailing Address - Fax:757-547-9439
Practice Address - Street 1:1101 MADISON PLZ STE 201
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5179
Practice Address - Country:US
Practice Address - Phone:757-547-2322
Practice Address - Fax:757-547-9439
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology