Provider Demographics
NPI:1295829521
Name:CARACENI, LESLIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:C
Last Name:CARACENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:CRONISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:155 BOSTON RD
Mailing Address - Street 2:#12
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1650
Mailing Address - Country:US
Mailing Address - Phone:774-279-7905
Mailing Address - Fax:
Practice Address - Street 1:155 BOSTON RD
Practice Address - Street 2:#12
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1650
Practice Address - Country:US
Practice Address - Phone:774-279-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF28108Medicare UPIN