Leslie J. Fodeman Md Controlled Substance Registration for Practitioner
12 Hills Point Rd, Westport, CT 06880


Leslie J. Fodeman Md is licensed in the eLicensing system of Connecticut. The license credential ID is 151076. The license type is CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER. The license status is ACTIVE. The address is 12 Hills Point Rd, Westport, CT 06880. The zip code is 06880.


Leslie J. Fodeman Md · 12 Hills Point Rd, Westport, CT 06880

Credential ID 151076
Name LESLIE J. FODEMAN MD
Type INDIVIDUAL
Address 12 HILLS POINT RD
WESTPORT, CT 06880
License Credential CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Full Credential Code CSP.0005555
Credential Type CSP
Credential Number 5555
Status ACTIVE
Status Reason CURRENT
Active 1
Effective Date 03/01/2015
Expiration Date 02/28/2017
Record Refresh Date 01/26/201

street_number: 12
route: Hillspoint Road (Hillspoint Rd)
locality, political: Westport
admin_level_2, political: Fairfield County
admin_level_1, political: Connecticut (CT)
country, political: United States (US)
postal_code: 06880
types : premise
latitude: 41.136406
longitude: -73.3423275
latlng: (41.136406, -73.3423275)


LESLIE J. FODEMAN MD · Connecticut Business

Leslie J. Fodeman Md · Physician/surgeon 12 Hills Point Rd, Westport, CT 06880

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