Provider Demographics
NPI:1013603943
Name:YOUNG, LESLIE A
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 MOUNT LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6613
Mailing Address - Country:US
Mailing Address - Phone:757-870-9833
Mailing Address - Fax:
Practice Address - Street 1:1702 TODDS LN STE 172
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3196
Practice Address - Country:US
Practice Address - Phone:757-870-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies