=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598786782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE RICHARD PYENSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9220 BEECH HILL DR
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-1945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-365-5710
-----------------------------------------------------
Fax | 301-365-0941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9220 BEECH HILL DR
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-1945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-365-5710
-----------------------------------------------------
Fax | 301-365-0941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D0026677
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD15621
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101030624
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------