LESLIE J. FODEMAN
Physician/surgeon


Address: 12 Hills Point Rd, Westport, CT 06880

LESLIE J. FODEMAN (Credential# 540435) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2018. The license expiration date date is February 28, 2019. The license status is INACTIVE.

Business Overview

LESLIE J. FODEMAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.012646. The credential type is physician/surgeon. The effective date is March 1, 2018. The expiration date is February 28, 2019. The business address is 12 Hills Point Rd, Westport, CT 06880. The current status is inactive.

Basic Information

Licensee Name LESLIE J. FODEMAN
Credential ID 540435
Credential Number 1.012646
Credential Type Physician/Surgeon
Business Address 12 Hills Point Rd
Westport
CT 06880
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1966-07-20
Effective Date 2018-03-01
Expiration Date 2019-02-28
Refresh Date 2019-06-03

Other licenses

ID Credential Code Credential Type Issue Term Status
151076 CSP.0005555 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 1999-03-01 2017-03-01 - 2019-02-28 LAPSED

Office Location

Street Address 12 HILLS POINT RD
City WESTPORT
State CT
Zip Code 06880

Licenses in the same zip code

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Toni L Bucker 4 Wild Rose Rd, Westport, CT 06880 Registered Nurse 2020-07-01 ~ 2021-06-30
Jee Hyun Kim 1 Allen Lane, Westport, CT 06880 Combination Nail Technician, Esthetician Or Eyelash Technici 2020-06-26 ~ 2021-07-31
Donna Vaccarella 15 Keyser Rd, Westport, CT 06880 Hairdresser/cosmetician 2020-09-01 ~ 2022-08-31
Sandra Gibson 12 Bayberry Ln, Westport, CT 06880 Registered Nurse 2020-08-01 ~ 2021-07-31
Adil Salam Md 44 Crawford Rd, Westport, CT 06880 Physician/surgeon 2020-07-01 ~ 2021-06-30
Joanne C Sosnoski 24 Hawatha Lane, Westport, CT 06880 Dental Hygienist 2020-08-01 ~ 2021-07-31
Rachel Lynn 495 Post Rd East, Westport, CT 06880 Eyelash Technician ~
Beginnings: An Infant/toddler Program 71 Hillandale Road, Westport, CT 06880 Group Child Care Home 2018-01-01 ~ 2021-12-31
Shelley S Ross 28 Old Hill Farms Rd, Westport, CT 06880 Dietitian/nutritionist 2020-08-01 ~ 2021-07-31
Robert W Van Summern 279 Wilton Rd, Westport, CT 06880 Architect 2020-08-01 ~ 2021-07-31
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Competitor

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City WESTPORT
Zip Code 06880
License Type Physician/Surgeon
License Type + County Physician/Surgeon + WESTPORT

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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