Healthcare Provider Details

I. General information

NPI: 1578973459
Provider Name (Legal Business Name): MEREDITH PESCE LESLIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH ROSE PESCE MD

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK STREET YALE NEW HAVEN CHILDREN'S HOSPITAL WEST PAVILION 2ND FL
NEW HAVEN CT
06504-8901
US

IV. Provider business mailing address

PO BOX 208064
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4081
  • Fax:
Mailing address:
  • Phone: 203-785-2022
  • Fax: 203-737-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number65589
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: