Organization
NORTHEAST KINGDOM HEMATOLOGY ONCOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE C LOCKRIDGE MD (OWNER/ SOLE PROPRIETOR)
(802) 334-7177
Entity
Organization
Contact information
Practice address
637 UNION ST, NEWPORT, VT 05855-5498
(802) 334-7177
Mailing address
637 UNION ST, NEWPORT, VT 05855-5498
(802) 334-7177
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1010044793
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346573235
INDIVIDUAL NPI
VT
Enumeration date
05/08/2015
Last updated
06/22/2020
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