Healthcare Provider Details

I. General information

NPI: 1376514562
Provider Name (Legal Business Name): LESLIE MACDONALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MOUNT AUBURN ST STE 103
WATERTOWN MA
02472-4191
US

IV. Provider business mailing address

521 MOUNT AUBURN ST STE 103
WATERTOWN MA
02472-4191
US

V. Phone/Fax

Practice location:
  • Phone: 617-926-2414
  • Fax: 617-926-8152
Mailing address:
  • Phone: 617-926-2414
  • Fax: 617-926-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number203471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: