Provider Demographics
NPI:1700987153
Name:DEANE, LESLIE ALLAN (MBBS, FRCSC)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ALLAN
Last Name:DEANE
Suffix:
Gender:M
Credentials:MBBS, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW STE 4C2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-1310
Mailing Address - Fax:202-865-3131
Practice Address - Street 1:2041 GEORGIA AVE NW STE 4C2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1310
Practice Address - Fax:202-865-3131
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21002125208800000X
FLME136154208800000X
CAA92635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A926350Medicaid
CA00A926350OtherBLUE SHIELD
CA00A926350OtherBLUE SHIELD
CAWA92635AMedicare ID - Type UnspecifiedPPIN