Provider Demographics
NPI:1962716928
Name:LEI S. CHARLTON, M.D., P.C.
Entity type:Organization
Organization Name:LEI S. CHARLTON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEI
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-649-1277
Mailing Address - Street 1:1122 N 25TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5254
Mailing Address - Country:US
Mailing Address - Phone:804-649-1277
Mailing Address - Fax:804-649-1026
Practice Address - Street 1:1122 N 25TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5254
Practice Address - Country:US
Practice Address - Phone:804-649-1277
Practice Address - Fax:804-649-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08624Medicare UPIN