1497872196 NPI number — DR. LESLIE ANNETTE GRANT ALBERT OD, FAAO

Table of content: DR. LESLIE ANNETTE GRANT ALBERT OD, FAAO (NPI 1497872196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497872196 NPI number — DR. LESLIE ANNETTE GRANT ALBERT OD, FAAO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT ALBERT
Provider First Name:
LESLIE
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD, FAAO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRANT
Provider Other First Name:
LESLIE
Provider Other Middle Name:
ANTTETTE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497872196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2813 UNIVERSITY BLVD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENSINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20895-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-933-1111
Provider Business Mailing Address Fax Number:
301-922-1490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2813 UNIVERSITY BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENSINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20895-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-933-1111
Provider Business Practice Location Address Fax Number:
301-922-1490
Provider Enumeration Date:
03/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  TA0791 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1578857694 . This is a "GROUP NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".