Healthcare Provider Details

I. General information

NPI: 1871157610
Provider Name (Legal Business Name): LESLIE FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N PARHAM RD STE 1
RICHMOND VA
23229-3156
US

IV. Provider business mailing address

2305 N PARHAM RD STE 1
RICHMOND VA
23229-3156
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax: 804-527-4728
Mailing address:
  • Phone: 804-828-2467
  • Fax: 804-527-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101274580
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: