MEDICARE: DR. LESLEY THOMPSON BRODIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	57553361205	UT
2	2084P0800X	Psychiatry Physician	261723-01	NY
3	2084P0800X	Psychiatry Physician	042-0012150	VT
4	2084P0800X	Psychiatry Physician	57553361205	UT
5	2084P0804X	Child & Adolescent Psychiatry Physician	261723-01	NY
6	2084P0804X	Child & Adolescent Psychiatry Physician	042-0012150	VT
7	2084P0804X	Child & Adolescent Psychiatry Physician	57553361205	UT
8	2084P0800X	Psychiatry Physician	287048	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720050552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLEY THOMPSON BRODIE M.D.

Provider Business Mailing Address
First Line	:	82 ELM ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9642
Country	:	US
Telephone Number	:	802-392-2146
Fax Number	:	802-367-1069

Provider Business Practice Location Address
First Line	:	82 ELM STREET
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255
Country	:	US
Telephone Number	:	802-367-1068
Fax Number	:	802-367-1069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	02/25/2022

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Directions to “ DR. LESLEY THOMPSON BRODIE M.D.” Practice Location

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