Healthcare Provider Details

I. General information

NPI: 1598022204
Provider Name (Legal Business Name): WENDY L LEFFEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 DEWEY ST
BENNINGTON VT
05201-2253
US

IV. Provider business mailing address

1151 NW HILL RD
POWNAL VT
05261-9448
US

V. Phone/Fax

Practice location:
  • Phone: 802-445-3039
  • Fax: 802-445-3026
Mailing address:
  • Phone: 802-558-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number042-0009231
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number265685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: