Individual
LESLIE DOUGLAS-CHURCHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 HOWARD AVE, YALE PHYSICIANS BUILDING, NEW HAVEN, CT 06519-1369
(203) 785-7411
Mailing address
800 HOWARD AVE, YALE PHYSICIANS BUILDING, NEW HAVEN, CT 06519-1369
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
55309
CT
207R00000X
Internal Medicine Physician
TN25944
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110103872
RR MEDICARE
TN
01
—
3005101
BLUE CROSS BLUE SHIELD
TN
05
—
3085941
—
TN
01
—
4509232
AETNA
TN
Enumeration date
05/09/2007
Last updated
07/29/2016
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