Provider Demographics
NPI:1225370117
Name:FORD, LESLIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:G
Last Name:FORD
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 1:5533 MOHICAN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2159
Mailing Address - Country:US
Mailing Address - Phone:301-518-0846
Mailing Address - Fax:301-435-3541
Practice Address - Street 1:5533 MOHICAN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2159
Practice Address - Country:US
Practice Address - Phone:301-518-0846
Practice Address - Fax:301-435-3541
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00169872083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine