Provider Demographics
NPI:1295731883
Name:RAIFORD, LESLIE S (NP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:S
Last Name:RAIFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101C WOODMARK ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1246
Mailing Address - Country:US
Mailing Address - Phone:540-672-0793
Mailing Address - Fax:540-672-3531
Practice Address - Street 1:101C WOODMARK ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1246
Practice Address - Country:US
Practice Address - Phone:540-672-0793
Practice Address - Fax:540-672-3531
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165444173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007794410Medicaid
VA12957318Medicaid