Provider Demographics
NPI:1235122417
Name:HEILIG, LESLYE ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLYE
Middle Name:ROBIN
Last Name:HEILIG
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 1:100 MAPLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1965
Mailing Address - Country:US
Mailing Address - Phone:413-528-4047
Mailing Address - Fax:413-528-3407
Practice Address - Street 1:100 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1965
Practice Address - Country:US
Practice Address - Phone:413-528-4047
Practice Address - Fax:413-528-3407
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA073130208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
26955OtherMVP
MA3067432Medicaid
817410OtherUNITED HEALTH
P625198OtherOXFORD
000000020948OtherBMC HEALTHNET
00979915OtherNY MEDICAID
10275301OtherCIGNA
MA0479OtherHEALTHNET OF THE NE, INC.
073130OtherCTCARE
10029273OtherCDPHP
28100OtherCHILDRENS MEDICAL
12991OtherHEALTH NEW ENGLAND
073130OtherTUFTS HEALTH PLAN
A64448OtherHARVARD PILGRIM HEALTH
J10138OtherBCBS OF MA
A64448Medicare UPIN
28100OtherCHILDRENS MEDICAL