MEDICARE: DAVID CLELAND LESLIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD011824E	PA

General Provider Information

NPI Number	:	1902135908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CLELAND LESLIE MD

Provider Business Mailing Address
First Line	:	2262 S MAIN STREET EXT
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3259
Country	:	US
Telephone Number	:	724-228-3219
Fax Number	:

Provider Business Practice Location Address
First Line	:	2262 S MAIN STREET EXT
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3259
Country	:	US
Telephone Number	:	724-228-3219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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