Provider Demographics
NPI:1811621857
Name:FENTON, LESLIE HALL (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:HALL
Last Name:FENTON
Suffix:
Gender:M
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14775-0749
Mailing Address - Country:US
Mailing Address - Phone:757-289-8273
Mailing Address - Fax:716-793-6172
Practice Address - Street 1:1313 CRANE CRES
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5662
Practice Address - Country:US
Practice Address - Phone:757-289-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine