Provider Demographics
NPI:1902165228
Name:LESLIE, BENJAMIN CURTIS (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CURTIS
Last Name:LESLIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-0158
Mailing Address - Country:US
Mailing Address - Phone:304-257-2527
Mailing Address - Fax:304-257-1469
Practice Address - Street 1:65 HOSPITAL DR
Practice Address - Street 2:SUITE 102 PETERSBURG
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9549
Practice Address - Country:US
Practice Address - Phone:304-257-2527
Practice Address - Fax:304-257-1469
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910007251Medicaid
WV2830OtherWV LICENSE
WV3910007251Medicaid