Provider Demographics
NPI:1265511554
Name:REYNOLDS, LESLIE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DENISE
Last Name:REYNOLDS
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 1:912 3RD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6967
Mailing Address - Country:US
Mailing Address - Phone:336-273-2511
Mailing Address - Fax:336-370-0287
Practice Address - Street 1:912 3RD ST
Practice Address - Street 2:STE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-273-2511
Practice Address - Fax:336-370-0287
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI700172084N0400X
ARE-156702084N0400X
VA01012711492084N0400X
NC96-017012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2234514OtherCIGNA
NC10331OtherBCBS
NC8910331Medicaid
NC2234514Medicare ID - Type Unspecified
NC2234514OtherCIGNA