Provider Demographics
NPI:1356329833
Name:GO, LESLIE S (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:GO
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 1:264 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2857
Mailing Address - Country:US
Mailing Address - Phone:413-586-3232
Mailing Address - Fax:413-582-7092
Practice Address - Street 1:264 ELM ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2857
Practice Address - Country:US
Practice Address - Phone:413-586-3232
Practice Address - Fax:413-582-7092
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156132208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3178757Medicaid
MAJ18734OtherBCBSMA
MD156132OtherTUFTS
MA156132OtherCONNECTICARE
MA000000006681OtherBMC
MA102463OtherCIGNA
MA22766OtherHEALTH NEW ENGLAND
MA2518317OtherAETNA
MA807847OtherHARVARD PILGRIM
G62918Medicare UPIN
MA102463OtherCIGNA