Healthcare Provider Details

I. General information

NPI: 1861516098
Provider Name (Legal Business Name): LESLIE C. ENTERLINE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UVA HOSPITAL WEST THE CANCER CTR HOSPITAL DRIVE
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

500 RAY C HUNT DR
CHARLOTTESVILLE VA
22903-2981
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-6356
  • Fax: 434-243-6086
Mailing address:
  • Phone: 434-980-6140
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840306
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: