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General NPI Number Information
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NPI Number | 1780604751
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Entity Type | Individual
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Provider Name | LESLIE A RICHARDSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone | 910-450-3712
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Fax | 910-450-3766
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Provider Business Mailing Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone | 910-450-4127
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Fax | 910-450-3766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 95-00703
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 95-00703
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License Number State | NC
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