MEDICARE: DR. LESLIE MARK KUTCHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	021151	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0V5161	OTHER	CT	HEALTH NET
2	ZS220	OTHER	CT	OXFORD
3	010021151CT01	OTHER	CT	ANTHEM BLUE CROSS
4	521151	OTHER	CT	CONNECTICARE

General Provider Information

NPI Number	:	1396790960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE MARK KUTCHER M.D.

Provider Business Mailing Address
First Line	:	255 BAYVIEW BLVD
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06615-7921
Country	:	US
Telephone Number	:	203-345-7109
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 BEACH RD
Second Line	:	SUITE 207
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-6017
Country	:	US
Telephone Number	:	203-255-2003
Fax Number	:	203-319-7583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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