MEDICARE: BENJAMIN CURTIS LESLIE D.O.

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	207R00000X	Internal Medicine Physician	2830	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2830	OTHER	WV	WV LICENSE

General Provider Information

NPI Number	:	1902165228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN CURTIS LESLIE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-0158
Country	:	US
Telephone Number	:	304-257-2527
Fax Number	:	304-257-1469

Provider Business Practice Location Address
First Line	:	65 HOSPITAL DR
Second Line	:	SUITE 102 PETERSBURG
City	:	PETERSBURG
State	:	WV
Zip	:	26847-9549
Country	:	US
Telephone Number	:	304-257-2527
Fax Number	:	304-257-1469

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	12/01/2016

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