Provider Demographics
NPI:1205844511
Name:BRANCH, LESLIE BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BERNARD
Last Name:BRANCH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2387 PROFESSIONAL HEIGHTS DR
Mailing Address - Street 2:SUITE 60
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3004
Mailing Address - Country:US
Mailing Address - Phone:859-277-1137
Mailing Address - Fax:859-278-0111
Practice Address - Street 1:2387 PROFESSIONAL HEIGHTS DR
Practice Address - Street 2:SUITE 60
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3004
Practice Address - Country:US
Practice Address - Phone:859-277-1137
Practice Address - Fax:859-278-0111
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-05-22
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Provider Licenses
StateLicense IDTaxonomies
KY27214207RA0201X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64272149Medicaid
KYF46096Medicare UPIN
KY1254203Medicare PIN