=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124182472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R. LESLIE SHELTON, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 11/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HOSPITAL RD SUITE 2B
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-840-6481
-----------------------------------------------------
Fax | 978-840-0506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 HOSPITAL RD SUITE 2B
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-840-6481
-----------------------------------------------------
Fax | 978-840-0506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT LESLIE SHELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-840-6481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------