Provider Demographics
NPI:1316295504
Name:CHARRON, LEIGH BREWSTER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:BREWSTER
Last Name:CHARRON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:S
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 BOSTON POST RD STE 10
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1554
Mailing Address - Country:US
Mailing Address - Phone:860-388-9799
Mailing Address - Fax:860-388-6646
Practice Address - Street 1:455 BOSTON POST RD STE 10
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1554
Practice Address - Country:US
Practice Address - Phone:860-388-9799
Practice Address - Fax:860-388-6646
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015762363A00000X
NY363A00000X
VA0110005268363A00000X
CT002981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03486959Medicaid
NY03486959Medicaid
CTD400123786Medicare UPIN
NYJ400078378Medicare PIN