Provider Demographics
NPI:1902135908
Name:LESLIE, DAVID CLELAND (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLELAND
Last Name:LESLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 S MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3259
Mailing Address - Country:US
Mailing Address - Phone:724-228-3219
Mailing Address - Fax:
Practice Address - Street 1:2262 S MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3259
Practice Address - Country:US
Practice Address - Phone:724-228-3219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011824E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37437Medicare UPIN