Provider Demographics
NPI:1114900834
Name:MARTIN, LESLEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-674-2100
Mailing Address - Fax:
Practice Address - Street 1:2571 PARK AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1901
Practice Address - Country:US
Practice Address - Phone:925-674-2100
Practice Address - Fax:925-689-5135
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77425207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH475XMedicare PIN
CAH82919Medicare UPIN
CABH475YMedicare PIN