Healthcare Provider Details

I. General information

NPI: 1720372683
Provider Name (Legal Business Name): LESLIE MAGIDA FARRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE DANIELLE MAGIDA

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 5021
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-8092
  • Fax: 503-803-9245
Mailing address:
  • Phone: 513-803-8092
  • Fax: 503-803-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101255990
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD043223
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.131135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: