Provider Demographics
NPI:1063635589
Name:DONOHUE, LESLIE RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:RENEE
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HARLECH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2508
Mailing Address - Country:US
Mailing Address - Phone:302-999-7386
Mailing Address - Fax:
Practice Address - Street 1:2700 SILVERSIDE ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-1524
Practice Address - Country:US
Practice Address - Phone:302-478-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0007932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80111Medicare UPIN