Healthcare Provider Details

I. General information

NPI: 1235122417
Provider Name (Legal Business Name): LESLYE ROBIN HEILIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLE AVE STE 1
GREAT BARRINGTON MA
01230-1965
US

IV. Provider business mailing address

100 MAPLE AVE STE 1
GREAT BARRINGTON MA
01230-1965
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-4047
  • Fax: 413-528-3407
Mailing address:
  • Phone: 413-528-4047
  • Fax: 413-528-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number073130
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: