Healthcare Provider Details

I. General information

NPI: 1144272915
Provider Name (Legal Business Name): LESLIE ANNE EARLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/07/2023
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 WATERLOO RD
JESSUP MD
20794-9783
US

IV. Provider business mailing address

2709 BLAINE DR
CHEVY CHASE MD
20815-3041
US

V. Phone/Fax

Practice location:
  • Phone: 443-204-6914
  • Fax:
Mailing address:
  • Phone: 301-944-4392
  • Fax: 301-933-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0043445
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: