Provider Demographics
NPI:1063712818
Name:LESLIE, SARAH R G (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:R G
Last Name:LESLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:108 ROADCAP RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-9048
Mailing Address - Country:US
Mailing Address - Phone:717-447-2910
Mailing Address - Fax:717-952-2075
Practice Address - Street 1:108 ROADCAP RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-9048
Practice Address - Country:US
Practice Address - Phone:717-447-2910
Practice Address - Fax:717-952-2075
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056256363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3103023Medicaid
NH3103023Medicaid