Provider Demographics
NPI:1811956808
Name:STEPHENS HANES, LESLEY AISHA (MD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:AISHA
Last Name:STEPHENS HANES
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 1:14334 BENSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-9617
Mailing Address - Country:US
Mailing Address - Phone:917-371-3849
Mailing Address - Fax:
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:BOX #065
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236300207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718954Medicaid
NY7B2581Medicare ID - Type Unspecified
NY02718954Medicaid